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.

전격성 경과를 취한 만성 호산구성 폐렴 환자 1예

윤호상,진춘조,유광하,이상엽,이수인,정상만,김선두,이순제,이길도,전혜정 건국대학교 의과학연구소 2000 건국의과학학술지 Vol.10 No.-

Chronic eosinophilic pneumonia(CEP) is a rare disease of unknown etiology characterized by chronic infiltration of the lung with eosinophils. It presents with profound systemic symptoms comprising fever, night sweats, weight loss, dyspnea and blood eosinophilia with nonsegmental air-space consolidation confined to the outer third of the lung, the "photographic negative of pulmonary edema". Histopathologic features of chronic eosinophilic pneumonia are intraalveolar and interstitial infiltrations with eosinophils, histiocytes, giant cells, scattered lymphocytes and plasma cells. Glucocorticoid therapy cause prompt resolution of symptoms as well as disappearans of blood eosinophils, elevated serum Ig E levels and the roentgenographic lesions. Infrequent radiographic findings include nodular infiltrates, consolidations, cavitations, atelectasis and pleural effusions. Deaths from CEP although rare, have been reported, but the majorities of CEP have benign courses and do not need a therapy with ventilator. We report a case of chronic eosinophilic pneumonia, which had a sudden course associated with diffuse pneumonic consolidations on the both lung and bilateral pleural effusion.

편측성 하악 과두 과증식으로 인한 안모비대칭의 치험례

김상규,이상한,장현중,우길상,이은진 대한악안면성형재건외과학회 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.1

Condylar hyperplasia is an uncommon malformation of the mandible created by excessive growth of one of the condyles. Condylar hyperplasia is a self-limiting condition, and treatment is determined by the degree of functional difficulty and aesthetic change. Some patients can be treated with unilateral condylectomy, whereas others require unilateral or bilateral mandibular osteotomies. Our method includes a condylectomy to arrest the continued condylar growth or to excise the neoplastic condyle, unilateral vertical ramus osteotomy to allow horizontal rotation of the mandible without significantly altering the temporomandibular articulations, and an arthroplasty by superior repositioning of the stump of the proximal condylar segment into the condylar fossa. Both the facial asymmetry and the occlusion were corrected by rotation of the mandible around the unaffected condyle.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(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 menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. 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 64.5% in 1998.

공공건설프로젝트에서 효율적인 건설분쟁처리에 대한 연구

이상범,조영준,김정길 동의대학교 산업기술개발연구소 2005 産業技術硏究誌 Vol.19 No.-

A In Korea when change order was occurred, contract amount may be adjusted according to Government Contract Act. If the requirement of privy is fully accepted, conflict can't arise. Because of a misunderstanding and misappropriation of contract, a difference between the contract condition and job site, an errors & omissions of the design document, the contract disputes has been increased since the Seoul 2nd Metro Project claims alleged by 6 Contractors at Feb. 1998. To mitigate and to resolve effectively construction dispute, training of construction participants, introduction of coercive arbitration clause in public construction, adaption of the lowest bidding system, participation of construction engineer in arbitration process were suggested in this paper.

뚜레장애에서의 주의력결핍 - 과잉운동의 양상

이혜련,민성길,김유진,오경자 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.3

More than 50% of Tourette's disorder patients have been reported to have an attention deficit-hyperactivity disorder. Eight Toutett's patients were compared with 11 attention deficit-hyperactivity patients and 8 non-referred children who were matched in age, sex and conner's hyperactivity score by parents, by the Continuous Performance Test(CPT) and the Matching Familiar Figure Test(MFFT). The number of errors in the MFFT by Tourett's patients is lower than those of the other two groups with statistical significance. The response time of Tourett's patients in the MFFT is much longer and the number of errors in CPT by Tourette's patients is fewer than in the other group. Conclusively, the characteristics of attention deficit-hyperactivity in Tourette's patients are different from those of the attention deficit-hyperactivity disorder. One possible reason for the difference is the obsessive-compulsive tendency, which about 50% of Tourette's patients have concurrently.

티타늄 레이저 용접부의 기계적 성질 평가

이중재,김길수,안승근,배태성,박찬운 大韓齒科器材學會 2003 대한치과재료학회지 Vol.30 No.2

This study was performed to examine the effects of laser output energy on the mechanical properties of laser-welded titanium joints. Titanium rods of 3 ㎜ in diameter were perpendicularly cut to 30 ㎜ in length for the laser welding. Two rods were fixed to each other with a jig and welded vertically using a Nd:YAG laser at output current of 210-270 A. The penetration depth of the laser beam against the titanium was measured with the changes of output current, pulse duration, and spot diameter. Mechanical tests included tensile testing and Vickers microhardness of the joints. Tensile testing was performed at the crosshead 00speed of 1.0 ㎜/min and a gauge length of 30 ㎜ with a universal testing machine. Vickers microhardness was mesured under 9.8 N load for 15 seconds. The results obtained were summarized as follows; With increasing the output current, the penetration depth of the laser to titanium was increased. Tensile strength values of laser-welded groups were the relatively higher than that of non-welded parent material group. There were significant differences in tensile strength between the specimens of laser-welded at output currents 250 A, 270 A and non-welded parent material group(p<0.05). Microhardness values were increased in the heat-affected zone. Brittle fracture regions were observed in the specimens of laser-welded at output currents 270 A.

초등학교 건축설계 유형과 설계심사시 관심분포에 관한 연구 : 1990년 이후 광주광역시 현상설계 당선안을 중심으로 Focused on the prizewinners in Competitions since 1990

이청웅,박길우,박성진 朝鮮大學校 建設技術硏究所 2001 建設技術硏究 Vol.21 No.1

From the point of time that 10 years passed since the design of elementary schools by prize contest has begun, the characteristics and types of architectural planning are classified with the selected works of the design of elementary schools by prize competition, the minimization of trial and error in planning elementary school through the design of elementary school by prize competition is sought in the side of qualitative improvement of educational environment through design contest, the minutes of screening works exhibited containing plan, design examination and improvement matters through the cooperation of East and West Board of Education, Gwangju and design offices selected and the checklists by new construction facility association of school building are collected in order to suggest the data as affirmative and effective design guideline the types of designs are classified in the side of the whole architectural planning after field survey, evaluation factors' of direct and indirect architectural design are summarized with reference to existing preceding research literatures and then the future considerations of design are to be extracted by analyzing the indication and improvement from design screening. In addition, the range of cases are 13 schools for the classification of architectural planning types among the prize winners' works of elementary school design from 1990 to 2000 and 17 schools in Gwangju for examining the distribution of concerns.

跆拳道 競技의 발차기 類型에 關한 硏究

李德成,鄭吉商 동국대학교 경주대학 1995 東國論集 Vol.14 No.-

The purpose of this article is to research kick patterns in taekwondo game. The research is based on the international taekwondo game held by KBS broadcast in 1994 where 12 countries attended. In the games the frequency of kick showed high in frequency and score rate. Back kick, front beat kick, back beat kick, and chop kick was not so high as front turning kick in frequency and score. But there was no statistical significant in these kick patterns. Attack in advance and counterattack also showed different scores and score rate. The frequency of counterattack showed statistical significant in kick patterns. So we need to develop kick techniques and scientific programs for a high score and for an effective game.