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.

[18F]FDG PET을 이용한 강박증 환자에서 뇌 포도당 대사의 이상에 관한 연구

권준수,이동우,이재성,최정임,이동수,정준기,조맹제,이명철,류인균 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 강박증에 대한 기능적 뇌영상 연구들에서 강박증 환자들의 안와전두엽과 미상핵의 대사율 증가 소견이 비교적 일과되게 발표되어 왔으며, 전두-피질하 회로의 이상이라는 이론이 수립되기도 하였다. 그러나 기존의 연구들은 강박증의 유병기간에 따른 구분없이 시행된 연구였고, 영상분석 방법에 있어서도 관심영역 방법을 이용했다는 한계를 지니고 있다. 본 연구의 목적은 첫째, 강박증의 유병기간에 따라 환자군을 구분하여 PET 영상소견을 분석함으로써 유병 기간에 따른 차이가 있는지를 조사하였으며, 둘째, 강바증 환자의 포도당 양전자방출 단층촬영(18-Fluor-deoxyglucose Positron Emission Tomography : FDG-PET) 영상분석에 통계적 매개변수 지도법(Statistical Parametric Mapping : SPM)을 이용함으로써 강박증의 병인기전 및 강박증상과 뇌기능 간의 관계를 명확히 규명하고자 하였다. 방법: 구조적 면담도구(Structured clinical interview for DSM-IV : SCID-IV)를 적용하여 진단된 12명의 강박증 환자들과 10명의 정상 대조군에 대해 FDG-PET을 촬영하여 SPM으로 분석하였다. PET 촬영 전 적어도 4주 동안에는 약물복용을 하지 않은 상태였다. 결과: 1) 환자군과 대조군의 비교 : 강박증 환자군은 대조군에 비해 양측 두정 영역의 대사율이 유의하게 감소되어 있었으며(P<0.01). 대사증가를 보인 영역은 없었다. 강박증의 유병기간이 10년 이상인 만성강박증 환자 4명은 양측 안와전두엽에서 유의한 대사증가 소견을 보였으며(P<0.01), 양측 두정영역에서 유의한 대사감소 소견을 보였다 (P<0.01), 유병기간이 10년 이하인 환자에서는 전체 환자군의 분석에서와 마찬가지로 대조군에 비해 유의한 대사증가 소견을 보인 영역은 없었으며, 양측 두정엽 부위에서 유 의한 대사 감소 소견을 보였다.(P<0.01). 2) 강박증상의 심각도와의 상관관계 분석 : 우측 두정엽의 대사율은 강박장애 척도 점수와 유의한 음의 상관관계를 보였으며(p<0.01), 양측 시상 영역의 대사율은 예일-브라운 강박장애 척도의 강박장애척도 점수와 유의한 양의 상관관계(p<0.01)를 보였다. 결론: 본 연구는 결과는 기존의 연구들에서 보고된 안와전두엽의 대사 증가 소견이 강박증의 만성화로 인해 나타나는 2차적 장애이며, 두정엽의 대사 저하가 보다 1차적인 장애일 가능성을 시사한다. Baxter가 수립한 전두-피질하 회로 이론은 두정엽의 이상을 포함하는 전두-두정엽 복합체 이론으로 확장되어야 할 것이다. Objectives: Functional imaging studies on obsessive-compulsive disorder(OCD) subjects have repeatedly reported increased metabolism in orbitofrontal lobes and caudate nucleus, resulting in the "frontal-subcortical" circuit abnormality theory. Limitations of the previous studies to date include little consideration for the duration of illness, and the use of regions of interest methods, as an image analysis method. Our study objectives are 1) to include the duration of illness as an important study variable, and 2) to use Statistical Parametric Mapping(SPM) method in order to tap relations between the brain function and the psychopathology and symptoms of OCD. Methods: The [18] fluorodeoxyglucose positron emission tomography(FDG-PET) scans of OCD subjects and normal comparison subjects, as diagnosed by the Structured Clinical Interview for DSM-IV(SCID-IV), were analyzed using SPM. Results: 1) Comparison of OCD and control groups : OCD subjects had significantly decreased metabolism in both parietal lobes and didn't have any areas of increased metabolism in comparison to comparison subjects(p.<0.01). four OCD subjects with the illness duration of 10 years or longer, had significantly increased metabolism in both orbitofrontal lobes<p<0.01). OCD subjects whose illness duration is shorter than 10 years didn't have any areas of increased metabolism and had significantly decreased parietal lobe metabolism, as in the analyses of all subjects(p<0.01). 2) Correlation analysis between areas and symptom severity : Metabolism of both thalamic sreas showed significant positive correlation with Yale-Brown Obsessive-Compulsive Scale(Y-BOCS) scores(p<0.01). Metabolism of right parietal area showed significant negative corre lation with Y-BOCS scores(p<0.01). Conclusions: The current findings suggest that the increased metabolism in orbitofrontal lobe, previously rported, may be a secondary phenomenon due to the extended illness dur- ation and that decreased metabolism in the parietal lobes are primary abnormality in OCD subjects. Thus Baxter's fronto-subcortical circuit theory should be extended into "fronto-pari-etal" complex theory, which includes the parietal lobes.

양전자방출단층촬영을 이용한 초점주의와 작동기억의 뇌 활성화 양상 비교

김재진,조상수,김명선,손정우,이재성,이동수,이명철,권준수 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.2

연구목적: 단순 초점주의 과제와 보다 고도의 집중을 요하는 작동기억 과제를 수행하는 동안의 뇌 활성화 양상을 비교하여, 두 인지기능 과정을 매개하는 정상적 신경회로의 특성과 차이를 알아보는 것을 목적으로 하였다. 방법: 정상인 14명을 대상으로 시각처리 대조 과제, 단순 초점주의 과제, 작동기억 과제 등 세 가지 인지과제를 주고, 과제 수행 동안 [□O]H₂O를 추적자로 한 양전자방출단층활영을 실시한 후 감산분석을 통해 초점주의와 작동기억의 신경회로 지도를 작성하여 비교분석하였다. 결과: 초점주의 동안 활성화되는 부위는 좌측으로 편측화되고 산발적으로 분포하는 양상이었고, 특히 전대상이랑과 운동영역을 포함한 전두엽, 일차 및 이차 시각피질 등의 활성화가 특징적이었다. 작동기억 동안의 뇌 활성화 역시 산발적 분포와 좌측 편측화 양상이 관찰되었으나, 시각피질보다는 전두엽의 활성화가 우세하였고, 특히 우측 전대상이랑의 현저한 활성화가 특징적이었다. 결론: 초점주의와 작동기억은 개념적으로 공통점과 차이점을 내포하고 있는 것처럼 매개 신경회로에서도 공통 혹은 특이한 영역을 각각 가지며, 전대상이랑의 역할이 두 기능에 공통적으로 중요하고, 이차 시각피질과 전전두피질이 두 기능 각각에 더 중요하게 작용하는 것 같다. Objectives:This study was undertaken to identify neural substrates for simple focused attention and more highly-focused working memory i normal people and investigate their characteristics and differences. Method: Fourteen normal subjects were studied with [□O]H₂O positron emission tomography during a visual processing baseline task, simple focused attention task and working memory task. Results were analyzed with the subtraction analysis to map the neural correlates of focused attention and working memory. Results: Activated areas during focused attention tended to be lateralized to the left and scattered over various regions including the anterior cingulate, motor area, and primary and secondary visual cortices. While the areas activated during working memory also show the left lateralization and scattered distribution, activation prevailed more in the frontal lobe than in the visual cortex, and was particularly remarkable in the right anterior cingulate. Conclusions: Focused attention and working memory do not have only conceptually commonalities and differences but also have common and specific areas in their neural substrates. The anterior cingulate may commonly play an important role in both cognitive functions, whereas secondary visual cortex and prefrontal cortex seem to be predominantly implicated in each function, respectively.

영유아예방접종시 보건소이용가정과 병의원 이용가정의 사회계층적 특성에 관한 분석연구

李恩珠,李明淑,車喆換 고려대학교 의과대학 1991 고려대 의대 잡지 Vol.28 No.3

In order to develop an appropriate health care service program for a population. it is of utmost importance that the particular population's demograhic and socio-economic characteristics are taken into consideration. The purpose of this research was to determine which of the demographic and socio-economic factors gathered from basic family health records contribute to the decision by people to use either the hospitals and clinics. or health centers for their children's health care. The target area of this study was Guro 6 dong. Guro-Ku, Seoul. A sampling method of choosing families whose children(1-3 years old) had already received their third DPT vaccination resulted in 405 subject familes out of 3904 family health records which were on file at the Guro 6 dong health subcenter A general survey of the households under study revealed that 61.9% of the children received the vaccinations at a health center. and 38.1%. at a clinic or a hospital. The demographic. socio-economic. and maternal health behaviour characteristics were all analyzed for each of the 405 families. In addition. the likelihood of each family to use either the clinic and hospital or the health center was analyzed. Significant differences in the data were determined by the Chi-squared methcd. The factors affecting the utilization of medical facilities ware examined through a stepwise discriminant analysis. using the type of medical facility utilized as group variable, and the demographic characterlistics socio-economic characteristics. or maternal health behaviour as discriminant variable. 1. Of the demographic characteristics. father's education. the mother's age. mothor'education. and the mother's occupation had a hit ratio of 58.0% 2. Upon the analysis of socio-economic characteristics, type of housing, status of ownership of the house, household income, and whether the family had a telephone had a hit ratio of 69.9%. 3. Using maternal health behaviour. as the discriminating variable, and prenatal care, postpartum care had a hit ratio of 70.9%. 4. The stepwise discriminant analysis resulted in postpartum care, type of housing, ownership status of the house, mother's occupation, monthly income, and ownership of telephone having a hit ratio of 73.4%. The collection of basic health information of a population is essential for planning an appropriate health care service program. This research has shown that, as part of the basic information, demographic, and scoio-economic, as well as maternal health behavior characterisics are very important in determinizing an individual's preference for a particular type of medical facility from the available ones. Furthermore, these specific characteristics of a population may be used in planning a comprehensive health care service program to make certain appropriate facilities and programs are available. More need to be done in the future to discover the factors which influence the effective utilization of health service programs available to the population.

일부 흉통환자에서의 ROC에 의한 CRP의 분석연구

이창규,이승관,강영태,장철수,최명재 高麗大學校 倂設 保健大學 保健科學硏究所 2000 保健科學論集 Vol.26 No.1

CRP measurement has been used in order to estimate the degree of acute inflammation or tissue necrosis caused by various factors, A lot of quantitative methods adopting different principle have been shown up since the international standards for CRP were confirmed by IFCC. Through the ROC analysis the authors want to presents the efficiency of the quantitative CRP measurement among the patients who came to the emergency room of a university hospital appearing chest pains.

부산 경남지방에 발생한 쭈쭈가무시병 64예의 임상적 고찰

이상훈,전명호,신병철,박기찬,김영효,배성,전광수,김종성 동아대학교의과대학 1992 동아의대학술지 Vol.4 No.1

재단각도 변화에 따른 오그림에 관한 연구 : 소매산둘레선상의 각도를 중심으로 About angles on the sleeve cap curve line

이명희,최석철 한국의류학회 1998 한국의류학회지 Vol.22 No.1

An investigation made of the easing contraction ratio according to sewing conditions (eased seam angle; 0˚20˚30˚45˚60˚70˚90˚, stitch density; 38 stitches/3cm(N1.0), 26 stitches/ 3cm(N1.5), 19 stitches/3cm(N2.0), 14 stitches/3cm(N2.5), 12 stitches/3cm(N3.0), thread; sp 60' s/2) by lockstitch industrial sewing machine with shirring foot. The results obstained were as follows: 1. The lower the stitch density, the higher the easing contraction ratio. 2. The easing contraction ratio at 0˚and 90˚were lower than bias angles (20˚, 30˚, 45˚, 60˚, 70˚). 3. As the results of visual test, the maximum easing conditions were Fl -0˚·20˚·30˚·45˚·-12 stitches/3cm(N3.0), 60˚·70˚·90˚-14 stitches/3cm(N2.5), F2 -0˚·20˚·30˚·60˚·70˚·90˚-19 stitches/ 3cm(N2.0), 45' -14 stitches/3cm(N2.5), and F3 -0˚·20˚·30˚·45˚·60˚·70˚·90˚-l.9 stitches/3cm (N2.0). 4. Approximately easing contraction ratio was obtained as 2.0% (N1.0)∼10.2% (N3.0) in Fl, 6.7% (Nl.0)∼15.7% (N2.0) in F2, and 5.2% (Nl.O)∼12.1% (N2.0) in F3, according to different angles on the sleeve cap curve line. 5. As a resuts of SPSS PC^+ statistics analysis, it confirmed the relations which were observed between easing contration ratio and stitch density, and easing contraction ratio was correlated with bending properties.

藥鍼이 Freund's Complete Adjuvant와 Peptidoglycan Polysaccharide에 의해서 誘發된 白鼠의 關節炎에 미치는 영향

李秉澈,한명관,羅昌洙 圓光大學校 韓醫學硏究所 1997 원광한의학 Vol.7 No.1

最近에 藥鍼療法이 많은 관심을 끌고 있다. 독특한 潤氣·六元의 原理에 依據하여 生體의 機能을 調整하고 病理狀態를 改變시켜, 疾病을 治療하는 新鍼療法중 하나이다. 이런 藥鍼療法은 매우 多樣한 疾患에 應用되고 있는데, 關節炎 治療에도 適用되고 있다. 牛黃·熊膽 藥鍼과 牛黃·猪膽 藥鍼의 效果를 比較 檢討하기 위하여 Freund's complete adjuvant와 peptidoglycan polysaccharide를 使用하여 關節炎을 誘發시킨 흰쥐에게 藥鍼을 施行하여 그 效果를 觀察하였다. Radioimmunoassy에 의한 PGE_2 含量을 測定하여 鎭痛 및 抗炎反應을 살펴보았고, 血液學的 檢査도 施行하였다. 또한 組織學的 所見을 觀察하여 組織의 損傷에 대한 回復程度를 比較檢討하였다. In order to investigate experimentally that Bovis Calculus, Ursi Fei Aqua-acupuncture(BUA) and Bovis Calculus, Susi Fei Aqua-acupuncture(BSA) have an effect on Arthritis in rats, the author inserted Aqua-acupuncture, electro-acupuncture, aspirin at corresponding with Chok-samni(ST36) and Hyunjong(GB39), and observed an concentration of the serum PGE_2 by method of the radioimmunoassay. The author also observed the histological feature of knee joint tissue. The results were as follows: 1. The BUA & BSA & aspirin group were decreased with statistical significance in the concentration of the serum PGE_2 as compared with the control group. 2. The BSA group were decreased with statistical significance in blood WBC as compared with the control group. 3. The control & experimental group were increased in blood RBC, Hb, Hct and decreased MCV, MCH as compared with the control group. 4. According to the histological studies, the BUA & BSA group were showed less than the control group in the damage of synovial cells and the least damage of synovial cells were showed in aspirin injection group.

치료 불응성 Still's병에서 자가 조혈모세포 채집시 사용된 G-CSF에 의한 급성 악화 1예

이재웅,박성현,왕준광,오호석,최정혜,배상철,이영열,김인순,최일영,안명주 대한조혈모세포이식학회 2003 대한조혈모세포이식학회지 Vol.8 No.2

치료 불응성 자가면역질환에서 고용량 항암화학요법 및 자가 조혈모세포이식술이 시행되고 있으나 조혈모세포 가동화 및 이식술 시 사용되는 G-CSF에 의해 오히려 기존의 자가면역질환의 증세가 악화되었다는 보고가 있다. 저자들은 만성적으로 재발되는 Still's병 환자에서 조혈모세포 가동화를 위해 사용한 G-CSF에 의해 자가면역질환이 급성 악화된 1예를 경험하였기에 보고하는 바이다. High-dose immunosuppressive therapy with autologous stem cell transplantation is an increasingly used treatment for severe refractory autoimmune disorder including multiple sclerosis, rheumatoid arthritis, juvenile chronic arthritis, systemic lupus erythematosus. Although the optimal method of collecting stem cell is not determined, G-CSF-based mobilization is generally considered safe. However, worsening of disease status was reported in autoimmune disease undergoing mobilization with G-CSF. We report a 24-year-old male with refractory Still's disease who developed acute disease flare after administration of G-CSF for stem cell mobilization.

중추신경계에 침범한 속립성 결핵 : 증례보고

이태환,김헌주,허철,한용표,홍순기,변진수,김명순,조미연,김윤미 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.11

in recent times, central nervous system(CNS) tuberculosis has been rare and the prevalence of the focal form, the tuberculoma, varies from 1 per 200 to 1 per 1000. CNS tuberculosis occurs as a result of hematogenous spread from a primary focus. mostly pulmonary tuberculosis. It can be diffuse exudative leptomeningitis or a localized tuberculoma ; the former is more common. We report a case of miliary cerebral tuberculosis in a 24-year-old female who had been having headaches for 4 months. Magnetic resonance imaging showed numerous small round Gadolinium-enhanced supratentorial and infratentorial lesions scattered throughout the brain. Histologic examination confirmed well defined tuberculous granulomas with central caseous necrosis in open biopsy, containing several acid-fast bacilli, the patient was treated with isoniazid, rifampin, ethambutol, pyrazinamide in combination with prednisolone.