항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

말초혈액에서 Tg mRNA에 대한 역전사 중합효소 연쇄 반응법의 갑상선 재발암의 분자생물학적 진단

권성일,박기룡,김현영,신채희,임영찬,최영식,박요한,이강대,장희경,이재화,염하용 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.4

연구배경: 갑상선암은 다른 조직에 발생한 암에 비해 비교적 천천히 자라므로 대부분 예후가 양호하지만, 일부에서는 주위 조직으로 침윤하거나 혹은 원격 전이로 인하여 치명적인 결과를 초래할 수 있다. 갑상선전절제술 및 131^I 제거술 후 경과 관찰시 갑상선암의 재발과 전이의 진단에 있어 131^I 스캔과 혈청 Tg의 측정이 현재 임상에서 가장 많이 이용되고 있으나 이 방법에는 여러 가지의 결점이 있다. 최근 Tg mRNA에 대한 RT-PCR법을 이용한 여러 연구결과는 131^I 스캔과 혈청 Tg 측정의 결점을 보완할 수 있는 좋은 보조적인 진단법으로 이용할 수 있을 가능성을 제시하였다. 이에 말초혈액에서 측정한 Tg mRNA에 대한 RT-PCR법이 갑상선 절제술 및 방사성요드 치료 후 갑상선암의 재발 및 전이 유무의 진단에 유용한가를 알아보고자 이 연구 시행하였다. 방법: 분화된 갑상선암으로 진단된 후 갑상선전절제술을 시행받고 방사성요드 치료를 받은 환자 중 현재까지 한차례에 이상 추적 방사성요드 전신 스캔을 시행하고 추적관찰이 가능했던 유두선암 35예, 여포선암 5예를 대상으로 연구를 시행하였다. 대상군은 131^I 스캔 소견상 음성인 군(Group Ⅰ), 잔여조직이 있는 군(Group Ⅱ), 국소전이가 있는 군(Group Ⅲ), 및 원격전이 군(Group Ⅳ)으로 구분하였다. 정상 대조군은 갑상선질환이 없는 10예의 건강인으로 하였다. 대상환자의 말초혈액을 이용한 Tg mRNA에 대해 특이적인 primer를 이용하여 RT-PCR 및 nested RT-PCR을 시행하였다. 결과: 본 연구 결과는 다음과 같다. 1) 131^I 스캔 소견상 음성인 군 21예 중 1예에서 Tg가 양성소견을 보였다. Anti Tg Ab가 양성인 4예 모두 Tg가 음성을 보였다. 잔여조직이 있거나 국소전이 및 원격전이를 보인 군 19예 중 Tg가 양성인 경우는 4예였으나, Tg mRNA는 전예에서 양성이었다. 2) 131^I 스캔에서 국소 및 원격전이 소견을 보인 8예 중 4예에서 Tg가 음성으로 131^I 스캔과 혈청 Tg 사이에 불일치 소견을 보였다. 3) 말초혈액에서 특이적인 primer를 이용하여 RT-PCR 및 nested RT-PCR을 시행한 결과 대상군 40예 및 정상 대조군 10예 모두에서 Tg mRNA가 양성을 보였다. 결론: 본 연구에서 갑상선 절제술 및 방사성요드 치료 후 갑상선암의 재발 및 전이 유무를 평가함에 있어 역전사 중합효소 연쇄 반응법을 이용한 Tg mRNA 측정의 의의는 재평가되어야 한다고 생각된다. Background: Differentiated thyroid cancer is the most common endocrine malignancy. Despite advances in the treatment of thyroid cancer, disease recurrence and metastasis may occur in as many as 20% of patients, and so continues to pose major problems in its clinical management. Serum thyroglobulin (Tg) measurements, by immunoassay, are used to detect residual or recurrent thyroid cancer following thyriod ablation. However, the usefulness of immunoassay is limited by both the requirement for thyroid hormone withdrawal, to attain optimal test sensitivity, and interference by the antithyroglobulin antibody (Anti-Tg Ab). Recent studies have reported the clinical usefulness of reverse transcription-polymerase chain reaction (RT-PCR) detection of Tg mRNA in the peripheral blood of patients with differentiated thyroid carcinomas. We performed this study to evaluated the usefulness RT-PCR of Tg mRNA in peripheral blood of patients with thyroid carcinoma following a total thyroidectomy and radioiodine ablation therapy. Methods: Forty cases that underwent a total thyroidectomy and radioiodine ablation therapy were included in this study. Of the 40 patients, 35 were papillary carcinomas and 5 were follicular carcinomas. Ten normal control subjects were also studied. Tg mRNA was extracted. Then RT-PCR and nested RT-PCR, were run with specific Tg primers. Concurrently, DNA sequencing of the isolates was carried out to prove the isolates were identical to the nucleotide sequence of the Tg. Results: The Tg was detected in 4 of 19 patients, with either a residual thyroid bed, or metastasis, on a 131^I whole body scan and in 1 of 21 patients with a negative radioiodine scan. Surprisingly, the Tg mRNA was detected in all the patients and normal controls. Conclusion: From our results we can not recommend Tg mRNA, detected by RT-PCR in peripheral blood, as a tumor marker superior to that of the Tg serum level. We consider an intensive re-evaluation of the method is required before considering its clinical applications (J Kor Soc Endocrinol 17:501∼513, 2002).

흉막삼출의 유무에 따른 쯔쯔가무시증 환자간의 비교

권세훈,김형호,강지인,하재하,한경택,이재록,김동민,권용은,윤성호,이승일 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1

Scrub typhus is a potentially fatal infectious disease caused by the organism Orientia tsutsugamushi. Clinical manifestations are fever, skin rash, eschar and varying degree of respiratory distress. The pleural effusion in scrub typhus is rare and secondary to the destruction of vascular endothelium. Because the respiratory symptoms are generally mild and the pleural effusion in scmb typhus is rare than in interstitial pneumonia, there are few comments about the characteristics of scmb typhus with pleural effusion. So we made the comparative study of scmb typhus patients between with pleural effusion and without pleural effusion. 연구배경 치명적일 수 있는 감염질환 중 하나인 쯔쯔가무시중(Scrub typhus)에서 드문 흉막삼출을 동반한 환자에 대한 고찰은 다른 문헌에서도 자주 언급되지 않았다. 따라서 본 저자들은 흉막삼출이 있는 경우와 없는 경우에 따른 쯔쯔가무시중 환자들을 비교하고자 하였다. 방법 2003년에서 2006년까지 조선대학교 병원 내과에 입원중인 환자 중 쯔쯔가무시중 진단을 받은 총 109명의 환자를 대상으로 하여 흉부 X선 검사 및 혈청학적 검사(CPK, LDH, ESR, CRP, AST, ALT, ADA), 혈액학적 검사(WBC, PLT) 및 백분율 검사등을 실시하였다. 결과 흉막삼출이 있는 환자들의 경우 흉막 삼출이 없는 환자들에 비해 ESR 수치가 통계학적으로 의의있게 높았다(p-vaule < 0.05). 결론 흉막삼출 유무에 따른 쯔쯔가무시중 환자간의 비교에 있어 ESR 수치가 통계학적인 의의를 가졌다.

朝鮮王朝時代 人口推定에 關한 一詩論

權泰煥,愼鏞廈 서울대학교 동아문화연구소 1977 東亞文化 Vol.14 No.-

In this study, we have attempted to estimate the population size of Korea during the entire period of the Yi dynasty, 1392-1910, utilizing various historical materials on population, mainly data from household registry and Hojog records. To evaluate the quality of the household registry data, we have conducted a partial examination of Hojog record and consistency checks for population figures for different years. Also population trends available directly from various historical materials have been analysed in terms of stable population concepts as to determine the extent of errors in population enumeration for various sub-periods. Based on those evaluations, we have developed a series of assumptions and methodological procedures for estimating the population size. The major findings in this study can be summarized as follows: a. Historical data on household and population in the Yi dynasty are of very poor quality with completeness between 10-50 per cent. b. Despite the fact that the quality of household and population data is poor, the population trends for the period 1639-1861 discerned from the reported figures respond receptively to the traditional factors in population change, such as famine, war, and other major miseries. c. From an analysis of Hojog record, a significant under-registration is noticed, for the child and young adult population, households without adult working males, and single households. d. The completeness of population registration in the Yi dynasty was closely associated with the average size of household reported. e. The population at the beginning of the dynasty (1392) was estimated as about 5,550,000. The population increased to about 14,000,000 two hundred years later just before the Korean-Japanese War in 1592. During the 45 years of socio-political disturbance, 1592-1637, in which two wars and a series of famines and epidemics took place, an absolute loss of 4,000,000 people was estimated. f. According to the estimates, the most marked growth of the population was observed during the 40 year period, 1654-1693. The population peaked in 1750 and again in 1807. The estimates were 18,660,000 and 18,620,000 respectively. The population at the end of the Yi dynasty (1910) was estimated at 17,430,000. g. The average annual rate of population growth during the entire Yi dynasty period was calculated as 0.22 per cent.

國民學敎 6學年 學生의 科學學力 調査 : 國民學生 科學學力 競試大會 結果 分析 Based on the result of science olympiad for elementary school students

河炳權,崔榮宰,李溶馥,崔泓琯 서울교육대학교 과학교육연구소 1994 科學과 數學敎育 論文集 Vol.20 No.-

다원적 기법에 의한 중소기업의 자금조달 실태

권광현,정정현,현영하 昌原大學校 産業經濟硏究所 1996 産經硏究 Vol.13 No.-

兒童의 科學槪念發達에 關한 硏究

金容德,河炳權 서울敎育大學校 1974 論文集 Vol.7 No.-

폐흡충에 의한 무균성 노흉에 대한 돼지꼬리형 도관(pig-tail catheter)을 이용한 치료의 효과

한경택,권세훈,김형호,하재화,선길홍,권용은,윤성호,이승일 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Background: Pulmonary paragonimiasis is caused by consumption of raw or improperlycooked crustacea infected with the laval stage (metacercaria) of Paragonimus westermani. The most characteristic symptoms were rust-colored sputum and cough. Paragonimiasis causes pleural thickening or effusion in 48% of the patients. Pleuro-pulmonary paragonimiasis can be easily overlooked by physicians who do not suspect this disease in the differential diagnosis. Method: We compared the outcomes of 11 patients with paragonimus empyema managed either through thoracotomy or pig-tail catheter drain. These patients were confirmed by food history, clinical and radiological findings, and laboratory data. Results: The male and female ratio was 1.75 : 1, and mean age was 40.0 ± 13.5 years. AII patients had pulmonary symptoms such as cough or chest pain. Serum-ELISA for paragonimiasis were all positive (mean titer was 0.57). AII patients had pleural effusion in radiological findings( 2 patients had bilateral pleural effusion). All patients received praziquantel (75 ㎎/㎏/day for 3days). Two patients were treated with thoracotomy and nine patients were treated with pig-tail drain. Hospital stay were 14.5 days in thoracotomy group and 5.6 days in pig-tail group respectively, Conclusion: Compared to the conventional thoracotomy grouP, the patients with paragonimus empyema who received pig-tail catheters had a significantly-decreased period of drain in situ, were clinically improved earlier, and were discharged earlier.

염산증기 흡입에 의해 발생한 화학성 폐렴 1예

장재혁,원경준,권세훈,하성일,권용은,이승일,윤성호 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.2

A 38-year-old man with dyspnea admitted to the emergency department after exposure to hydrochloric acid in pharmaceutical product manufacturer. Crackle was auscultated in both lung fields in initial physical examination. Chest radiograph showed consolidation and diffuse parenchymal infiltration in both lung fields. Arterial blood gas analysis showed severe hypoxia. This patient was treated by mechanical ventilation, corticosteroid, antibiotics and bronchodilators and was improved completely in a week after the admission. The authors report a rare case of chemical pneumonitis caused by hydrochloric acid.

지난 4년간 학회지 "신경정신의학" 심사 평가보고

오병훈,권준수,남궁기,김승현,지익성,김창윤,하규섭,박원명,김성곤,오강섭,김정범,이수정,정한용,이창욱,박용천,이영문,김세주,이병욱 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.5

Four Years Reports of "Journal of Korean Neuropsychiatric Association" during 2001 to 2005 were evaluated by 18 Editorial Board of Korean Neuropsychiatric Association. We investigated the articles to specific fields and rejection rate etc. by different section chiefs. Although several problems concerning review time duration and rejection guideline issues indicated but generally all reviewer processes proved relatively clear and concise criteria. Through these objective and systematic evaluation Processes, "Journal of Korean Neuropsychiatric Association" will develop a good journal.