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.

인체 유방암종에서 Cyclic-Dependent Kinase Inhibitor, p27^Kip1 발현의 의의

송상용,김덕환,서연림,고영혜,김대식,남석진,양정현 대한병리학회 1998 Journal of Pathology and Translational Medicine Vol.32 No.12

응급실 내원시 예상치 못한 사망 환자의 예측 인자

김욱진,서정필,정성필,황태식,이한식 대한응급의학회 1998 대한응급의학회지 Vol.9 No.4

Background: Unexpected deaths of the patients at ED are surprising to the medical staffs as well as the families. It may also increase the possibilities of medico-legal problems. This study was conducted to review the unexpected death in ED and find the predictive factors leading patients to unexpected death. Methods: A retrospective study with reviewing available medical records of 183 patients who were expired at Ed of Shinchon Severance Hospital from Mar. 1997 to Feb. 1998 and 103 patients of Youngdong Severance Hospital from Mar. 1996 to Feb. 1998 was done. Analyses were done on 30 variables of physical findings, laboratory results, procedures and therapies. We used univariate analysis such as t-test and x²-test and multiple logistic regression analysis. Results: Of the total 286 deaths in Ed, 153 cases were enrolled in this analysis. The number of unexpected deaths were 76. Age, mental status, fraction of neutrophil count, BUN level, whether endotracheal intubation was done, use of inotropics were the factors with statistical significance on the univariate analysis, but only comatose mentality, endotracheal intubated case, and use of the inotropics were significant on logistic regression analysis. The longer the ED length of stay, the higher the rate of mortality and unexpected death. Conclusion: This result suggest that medical attention is needed on the patients with comatose decreased mental status, endotracheally intubated case and needing inotropic agents to prevent unexpected deaths shortening the ED length of stay may also be a factor for decrease the unexpected death rate.

자동창고의 적체현상에 관한 연구

金昌郁,金聖植,裵卿漢 한국경영과학회 1990 經營 科學 Vol.7 No.1

Automated Storage/Retrieval Systems(AS/RS) are modeled and analysed by the M/G/1 queue with vacation. The model contains two queues(one for storage, one for retrieval), a common server(S/R machine) and a storage unit. Though the probabilities are usually very small, in two extreme cases(storage racks are completely empty and completely full) the two queues govern each other's behavior, and thus it denies the independency among the queues, a necessary condition required in the M/G/1 queue with vacation. Therefore the results obtained are only approximations. Single command and dual command schemes are employed as the AS/RS operation policy and analyses are performed for both the cases.

신장의 원시성 신경외배엽 종양

송상용,조은윤,이정원,고재향,김미경,김대식,고영혜 대한병리학회 1998 Journal of Pathology and Translational Medicine Vol.32 No.3

흰쥐에서 출혈량에 따른 비장세포 증식력과 말초임파구 아형의 변화

이한식,정성필,김욱진,조영순,장석준 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: Hemorrhage itself has been shown to produce abnormalities in immunity, particularly depression of the lymphocyte function. In order to better examine the amount of hemorrhage required to suppress the lymphocyte function, we determined the effect of graded fixed-volume hemorrhage on splenocyte proliferation and the lymphocyte subpopulation. Methods: Male Sprague-Dawley rats(weight,350∼400 g) were anesthetized, subjected to hemorrhages of 7.5 ㎖/㎏, 15 ㎖/㎏, and 22.5 ㎖/㎏ by percutaneous cardiac puncture with ㎖/㎏ needles, After 1, 2, 4, and 7 days, animals were killed to obtain the blood and spleen. The splenocyte proliferative capacity was measured by using the tritiated thymidine incorporation technique, and the peripheral lymphocyte subpopulation was determined using flow cytometry with the following monoclonal antibodies: T cell(CD3+), T helper cell(CD4+),7 cytotoxic cell(CD8+), and B cell(CD45RA+). Results: Hemorrhage of 7.5 ㎖/㎏ did not induce depression of splenocyte proliferation. However, for hemorrhage greater than 15 ㎖/㎏, the splenocyte proliferative capacity was significantly depressed at 2 days after hemorrhage and recovered at 4 days. Hemorrhage induced no changes in the relative percentage of lymphocyte subpopulations and in the number of each cell in peripheral blood. Conclusion: This study suggests that cellular immunity is depressed at 48 hrs after a hemorrhage greater than 15 ㎖/㎏ without any change in the peripheral lymphocyte subpopulation.

웨이브렛 변환을 이용한 고압축 ITTBC

고성식,김정화 조선대학교 전자정보통신연구소 2000 電子情報通信硏究所論文誌 Vol.3 No.1

In this paper, we proposed new image coding method consisting of domains by using the wavelet transformed pool The proposed method used quadtree partition on the wavelet transformed pool as a preprocessing to optimize a number of range and to reduce a number of affine transform, and took codebook by domain class on the wavelet transformed pool to enhance similar block searching time, because present ITTBC(Iterated Transformation Theory Based Coding)s using a fractal image coding method takes also a lot of coding time to search a similar block As a result, proposed image compression ratio can be improved by about 86 40% compared with the Jacquin's method when keeping decoded image PSNR 40[㏈], and the searching time can be reduced to 99 65%

웨이브렛 변환영역에서 정의역 클래스 코드북을 이용한 ITTBC

고성식,김정화 조선대학교 에너지.자원신기술연구소 2000 에너지·자원신기술연구소 논문지 Vol.22 No.1

Most ITTBC(Iterated Transformation Theory Based Coding)s using a fractal image coding method takes also a lot of coding time to search a similar block. In this paper, we proposed the image coding method consisting of domains by using the wavelet transform pool. The proposed method used quadtree partition on the wavelet transform pool as a preprocessing to optimize a number of range and reduce a number of affine transform, and took codebook by domain class on the wavelet transform pool to enhance similar block searching time. As a result, the image compression ratio can be improved by about 89.16% compared with the Jacquin's method when keeping decoded image PSNR 34[dB], and the searching time can be reduced to 99.65%.

프랙탈 코딩 파라미터를 이용한 디지털 영상 워터마킹

고성식,조강석,정용덕,김정화 조선대학교 전자정보통신연구소 2003 電子情報通信硏究所論文誌 Vol.6 No.1

In this paper we propose new watermarking method that a secret key is created from image contents without inserting an watermark in the image contents and the watermark is transformed to the fractal parameters Image logo watermark uses the owner photograph of the image contents and after image watermark is transformed t o the fractal parameter between domain and range of the watermark logo by using fractal theory, the fractal parameter is scrambled by the created secret key Thus, our algorithm proposed in this paper has no image distortion by an watermarking because of decoding the watermark by the created secret key Experimental results have shown that the proposed method achieves improved robustness with respect to image lossy compression, cropping attacks and various filtering attacks.

병원간 응급의료 전달체계에 대한 연구 : 영동세브란스 병원 응급진료센타를 중심으로

최성욱,김인병,이한식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Transporting an emergent patient to a hospital has a crucial role in proper patient care. Objective of this study is to review the current methods and various patient transport system used between the hospital. We have conducted a retrospective analysis of consecutive 753 patients who was transport-in and out from emergency department of YoungDong Severance Hospital from Sep. 1, 1994 to Feb. 28, 1995. All transferred patients were divided into two large category of trauma versus non-trauma, 363 to 390 patients, respectively. Average ISS(injury serverity score) for trauma patients were 7.31 point and average GCS score of 14.29 point for non-trauma patients. Most of the patients were trasfered-in during day and evening hours(84%), but there was no peak hours for transfer-out patients. Little more than half of all transferred patients used ambulance as a mode of transportation. Among all transfer-in patients, 65% were admitted for general care, emergency operation and ICU care. Others, 17%, 18% were discharged or transfer-out to other hospital, respectively. For transfer-out patients, 72% of transfer-out patients were for admission following recommandation by an emergency physician. Each level of hospital was divided into 4 subgroup ; private clinic, small hospital, general hospital and university hospital. ISS was also divided into score less than 10 points for mild and more than 11 points for moderate to severe injury. As a results, all of patients transferred from private clinic bad less than 4 point of ISS. Where as increasing percentage of patients with higher ISS was transferred-in from higher level of hospitals. Transfer-out hospitals were carefully selected by emergency physicians according to patient health status, speciality of referring hospital and closeness to patient residence For non-traumatic patient, GCS score was divided into GCS score 14or less and 15 point. Similar to trauma patient, there was increasing percentage of patient with lower GCS score transfer-in as hospital level increase. Patients with ISS less than 10 point and GCS score 15 point can be transferredto anappropriate level of hos-pital if EMSS operates properly. We suggest with a well organized EMSS, mandatory inter-hospital communication and good transfer record, proper patient transfer and treatment can be achieved.