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.

尿中 鉛 및 蛋白質 排泄量의 補正方法에 關한 實驗的 硏究

兪炳龍,廉容泰,李恩一 고려대학교 의과대학 1994 고려대 의대 잡지 Vol.31 No.1

One of the most important issue in occupational health is to estimate the exposure status or health effects of workers by hazardous chemicals through biological monitoring. The one of the most commonly used tests in biological monitoring to assess the internal doseof a chemical is the measurement of a metabolite or sometimes of the chemical itself in urine. Results from a 24-hour specimen is most representative of average body burden, but it is more difficult to obtain, so it is impractical and more likely to be contaminated. Therefore the analyses are commonly performed on "spot" specimens, and it is necessary to correct the results for the dilution of the urine in order to obtain a reliable estimation by adjustment methods. The most commonly used methods are the specific gravity method and the creatinine method. But these adjustment methods are not reliable satisfactorily, and some other adjustment methods have been suggested by some researchers. This study had been done to develop more reliable adjustment methods of protein and lead measurement in spot urine, and to seek the factors which affect the variability of spot urine. The subjects were 10 workers who had been exposed to lead above TLV. The results were as follows : 1. The coefficients of variation of lead in urine were greater than those of protein both in 21 hour urine specimen and in spot urine specimen. And in the results in spot urine specimens, the coefficients of variation of adjusted concentrations were less than that of unadjusted concentrations of both the protein and lead. 2. The correlation coefficients of urinary lead(adjusted concentration and unadjusted concentration) between in spot urine specimen and in 24-hour urine specimen were 0.6-0.8, and those of creatinine adjusted value between in spot urine specimen and in 24-hour urine specimen were lower in workers who had high level of blood lead(<40㎍/dl) than in workers who had low level of blood lead(>40㎍/dl). 3. The correlation coefficients of urinary protein(adjusted concentrations and unadjusted concentration) between in spot 'urine specimen and in 24-hour urine specimen were 0.6-0.8, and those of creatinine adjusted value between in spot urine specimen and in 24-hour urine specimen were lower in workers who had high level of blood lead(>40㎍/dl) than in workers who had low level of blood lead(<40㎍/dl). 4. The spot urine concentrations adjusted by log-creatinine both of protein and lead were correlated highest to 24 hour urine concentrations in all three adjustment methods such as creatinine adjustment, log-creatinine adjustment and specific gravity adjustment method. 5. The important factors which affect the variation of spot urine were specific gravity in urinary lead, and specific gravity and urinary volume or blood lead and specific gravity in urinary protein. 6. Urinary lead concentrations was not affected seriously by urinary creatinine and urinary volume, but urinary protein concentration was affected largely by urinary creatinine, specific gravity and urinary volume. The urinary protein adjusted by specific gravity was less affected than other adjustment methods. 7. The recommended adjustment method for urinary lead and protein in worker exposed to lead above TLV is log-creatinine method and specific gravity method.

아세클로페낙 연질캡슬(클란자 에스 연질캡슬)의 개발

용철순,이경희,최진석,박병주,정세현,김용일,박상만,배명수,김귀자,김영식,유창훈,강성룡,유봉규,이종달,최한곤 한국약제학회 2004 Journal of Pharmaceutical Investigation Vol.34 No.1

To develop and aceclofenac soft capsule, four preparations with various solubilizers were prepared and their dissolution test was carried out. Among four preparations tested, a preparation with ethanolamine was selected a formula of aceclofenac soft capsule (Clanza S^(™), since it showed the fastest dissolution rate. Bioequivalence of aceclofenac tablet, Airtal^(™)(Dae-Woong Pharmaceutical Co., Ltd.) and aceclofenac soft capsule, Clanza S^(™)(Korea United Pharmaceutical Co., Ltd.) was evaluated according to the guideline of KFDA. Fourteen normal male volunteers (age 20-25 years old) were divided into two groups and a randomized 2×2 cross-over study was employed. After oral administration of one tablet or capsule containing 100 ㎎ of aceclofenac, blood ws taken at predetermined time intervals and the concentration of aceclofenac in plasma wa determined with an HPLC method under UV detector. The pharmacokinetic parameters (C_(max), T_(max) and AUC_(t)) were calculated and ANOVA was utilized for the statistical analysis of parameters using logarithmically transformed AUC_(t), C_(max) and T_(max) between Airtal tablet and Clanza soft capsule were 2.89%, 0.18% and 43.0%, respectively. There were no sequence effects between two formulations in these parameters. The 90% confidence intervals using logarithmically transformed data were within the acceptance range of log(0.8) to log(1.250(e.g.log(0.81) - log(1.23) and log(0.89) - log(1.14)) for AUC_(t) and C_(max), respectively. Thus, the criteria of the KDFA guidelines for the equivalence was satisfied, indicating that Clanza S^(™) soft capsule is bioequivalent to Airtal^(™) tablet.

ZnS:Cu,Cl형광체의 제조와 발광특성

박조용,한상도,김병권,정영호,S. P. Khatkar,Liang, Yu Jun 경북대학교 센서기술연구소 2002 센서技術學術大會論文集 Vol.13 No.1

河床變動 豫測에 관한 硏究 : 密陽江이 合流하는 洛東江 本流地域을 中心으로

閔丙亨,李承輝,閔一圭,兪甲鎔,吳尙龍 동아대학교 건설기술연구소 1996 硏究報告 Vol.20 No.1

In this study, when we collect river bed sediment at the point where mainstream of Nak Dong river join branch of Mil Yang river, the change of river bed around downstream area was estimated and based on experimental data using three dimensional unsteady flow model about the water level to quantity of water and velocity and river bed change through numerical imitation experiment and hydraulic model experiment.

CuGaSe_2 薄膜의 光電氣的 特性에 關한 硏究

김영일,금채,허복희,김유배,이병주 충남대학교 1990 忠南科學硏究誌 Vol.17 No.2

간질에 대한 임상적 고찰

최진영,유병연 건국대학교 1995 學術誌 Vol.39 No.2

Epilepsy occurs in all age groups with a variety of diseases that alter neuronal function in a specific way. In spite of the development in diagnosis and treatment of epilepsy, epileptic patients were treated inappropriately and are often handicapped by the psychosocial consequence of their conditions, The purpose of this study is to provide reference and education to patients and their families. Clinical study via chart review was carried out on 110 patients with seizure who visited outpatient department of neurology and were consulted from other departments, Kon Kuk University Hospital from July, 1990 to August, 1993. The results were as follows : Males were more affected than females in the ratio of 1.89 :1. In their distribution of age, teens were most frequent(38.18%). seizure occured most frequently in the first decade(35.45%). The seizure types were : generalized seizure 86.36%(tonic-clonic 74.54%, tonic 8.18%, clonic 1.82%, atonic0.19%, atypical absence 0.91%) : Partial seizure 13.63%(complex partial 7.27%, secondary generalized6.37%). Causes of seizure were idiopathic(58.18%), trauma(13.63%), developmental(8.18%), cerebrovascular disease(7.27%), etc. The major part of all idiopathic cases had their attack of seizure before 30 years of age and those of symptomatic cases were rather late over age of 30. On EEG, abnormal findings were noted in 66.99%. Abnormal EEG findings were found more commonly in complex partial seizure(71.43%) than generalized seizure(66.67%) and secondary generalized seizure(66.67%). On brain CT scan, abnormal findings were noted 52.94%, and the abnormal findings were found more commonly in complex partial seizure(66.77%) than generalized seizure(54.54%) and secondary generalized seizure(25%). Abnormal brain CT scan findings were noted in 46.67% of normal EEG patients and in 51.52% of abnormal EEG patients. Most frequently used antiepileptic drug was carbamazepine. The serum level of antiepileptic drugs was in therapeutic ranges and clinical effect was good. Epileptic patients can perform daily activities without any handicap if they are properly treated. We should educate the community against the miss-belief about epilepsy.

부정류 흐름을 이용한 부유물질 확산모형에 관한 연구

민병형,이승휘,민일규,유갑용,임대영 東亞大學校 海洋資源硏究所 1996 硏究論文集 Vol.9 No.1

To investigation the diffusion of suspended material we use a 3-D unsteady numerical model based on the Euler method. We applied the model to mainstream of Nak Dong River confluence of Miryang river place at KyungNam kimhae-Si Saenglim-Myon Masa-Ri. We pridicted the concentration of suspended material due to dredging at a near by water-supply intake.

교육대학 학생을 위한 초등학교 성교육 지도자료 개발

송광용,김지자,유병일 서울敎育大學校 學生生活硏究所 2003 學生生活硏究 Vol.28 No.-

본 연구는 교육대학의 성교육에 대한 이론적 기초를 확립하여 예비교사들로 하여금 성에 대한 바람직한 이해와 전인적인 성장이 가능하도록 도울 수 있는 체계적 성교육의 틀을 제시하기 위한 목적으로 이루어지게 되었다. 이를 위해서 성에 대한 다양한 이론적 배경 고찰, 국내외 초등학교에서의 성교육 실시 사례 분석, 교육대학생을 위한 성교육 지도자료 및 구체적 성교육 내용 등을 중심으로 연구가 수행되었으며, 주요 결과들을 요약하면 다음과 같다. 우리나라 초등학교 성교육은 주로 보건교사들이 담당함으로써, 시수의 확보에서나 일반 학생지도에서 통합적으로 이루어지지는 못하고 있으나 성교육 지도의 전문성이 확보된다는 면에서 장점을 지니고 있다. 그러나, 현실적으로 일선 초등학교에서 한 명의 보건교사가 학교 전체 학생들을 대상으로 성교육을 하기에는 무리가 따르므로, 담임교사가 성교육 연간 시수의 일부 시간을 분담, 의뢰받아서 성교육을 담당하고 있는 것으로 나타났다. 그러므로, 초등학교에서 성교육을 제대로 실행하기 위해서는 먼저 모든 교사들이 그 지도내용과 수업운영에 대해 충분히 숙지할 수 있도록 해야 된다고 보여진다. 미국의 성교육은 주에 따라서 또는 학교에 따라서 다양하며 1988년부터 국가에서 AIDS 확산과 10대 임신을 방지하기 위해서 기존의 교육과정에 성교육을 통합적으로 가르치도록 교육기관에 기술적, 재정적 지원을 해오고 있다. 캘리포니아 주의 학교 성교육을 살펴보면, 학교에 배치된 간호사와 주 소속 보건통계의 교육훈련 연구팀에 의하여 실시되었으나, 최근 들어 교육 예산의 절감으로 여러 개의 학교를 한사람이 담당하게 되는 학교 구 담당 간호사들이 학교를 방문하여 보건교육과 더불어 성교육을 실시하고 있다. 성교육 시행 횟수는 한 학기에 1회 이상을 목표로 하되 대상을 학년별로 또는 남녀학생을 별도로 하여 실시한다. 한편, 학교 성교육 실시에 대한 미국 사회의 분위기는 대체로 보수적이어서 학생들의 학교 성교육 시간에 참여 가능 여부를 사전에 학부모에게 통보하여 동의서를 받아오는 학생에 한하여 교육을 받도록 하고 있다. 일본의 성교육은 원조교제의 저연령화와 어린이 성폭행 사건의 증가 등의 사회적 문제로 인하여, 1999년부터 일본 문부성이 제작한 "성교육의 사고와 진행방식"이라는 지도자료를 중심으로 유치원, 초, 중, 고등학교에서 조직적으로 실시할 수 있도록 장려하고 있다. 대부분의 초등학교에서는 성의 생리학적, 심리적, 사회적 측면을 포함하는 폭 넓은 인간교육을 지향하는 성교육 부독본을 교재로 채택하고 있으며, 6년간 교육과정에서 약 12시간 정도를 성교육 시간으로 할애하고 있다. 일부 학교에서는, 저학년과 여아 아이들을 대상으로 하는 첫 월경교육의 경우 부모들이 수업참관을 실시하여 그 반응을 참고로 성교육의 충실성을 도모하기도 한다. 국내외 초등학교 성교육 실시 사례들을 종합해 볼 때, 성교육의 내실을 다지기 위한 학교와 학부모간의 협력체제 구축 노력 뿐만 아니라 국가적 차원에서의 중요성 인식과 더불어 성교육 과정 및 프로그램 개발, 성교육 관련 연구 등에 국가차원에서의 적극적인 지원이 일부 이루어지고 있음을 볼 수 있다. 우리나라의 초등학교 성교육이 보다 내실있게 이루어지기 위해서도 이와 같이 성교육 교육과정과 성교육 프로그램 및 자료들이 충분히 개발되고 검증될 수 있도록 보다 적극적이고도 지속적인 지원 노력이 요구된다고 보여진다. 끝으로, 본 연구에서는 남녀의 신체적, 심리적 특성을 이해함으로써 긍정적인 자아개념의 형성과 원만한 사회 생활 영위, 양성 평등의 성역할을 이해함으로써 책임있는 성행동을 하도록 한다는 교육인적자원부의 성교육 목표를 기초로 하여, 초등학교 성교육의 영역과 내용 및 성교육 지도 프로그램의 실제 등을 구체적으로 제시함으로써 예비교사들의 성교육 내용에 대한 보다 체계적이고도 심회된 이해를 도모하고자 하였다 As the problems of sexual harassment among teenagers have increased rapidly, the school has focused on developing prevention program. As a result, many publications related on sexual harassment that can use on class is appearing. Like a most social problem, the sexual harassment have an emphasis on prevention than after treatment. Now, we have to emphasize on systematic sexual education for every class of school. The purpose of this study is to develop the basic theoretical sexual education at the university of education, therefore future teachers comprehend about well organized sexual education. Due t this purpose. We researched various factors such as different theoretical inquiry, domestic and foreign sexual education that have been taken place, teaching material of sexual education for the students of university of education and content of core sexual education. The summary of significant result is following sentences. The domestic sexual education in elementary school is not based on the teacher who is on charge of class, the teacher of preservation of health is taking care of sexual education, it ensures the professional teaching method for students. however, it is difficult to manage the time schedule for all the elementary school. In a reality, it is difficult to apply on count of lack of professional teacher of preservation of health. In accordance, school teachers are teaching classes some part of annual time schedule. For those reasons, the school teachers hsould educate themselves familiarity on the subject. In the United States, sexual education has been practiced in variety way in compliance with States or school. The nation has supported sexual education to prevent spread of AIDS and teenager pregnancy. According to the California State's sexual education system, there is not a cast that teachers are teaching sexual education for their classes. The sexual education was taught by professional teacher from preservation of health. However, the system is changed to one professional teacher taking care of several school since the cutback of State budget. The number of classes will be more than on time per semester. The education class will be divided to grade or sex. The atmosphere of society toward sexual education taking place in school is conservative therefore the school teaches only students who have permission from their parents about sexual education. In Japan, there are numerous social problems related with increasing sexual harassment such as prostitution of teenagers. In addition, the government encourages organized education in kindergarten, primary, middle, and high school with a text book which is produced by Education department of japan, called "Cognition and Process of Sexual Education". A large percent of primary school takes a supportive moral human nature supplementary reader that include biological, psychological, and social sexual education. It takes 12 hours of 6 years curriculum, some portion of primary school may make class subject to lower grade and female student teach women period. They also invite students' parents to accommodate the devotion if education. In summary, not only to make an effort to unite parents of students and school is important but also government's effort to support the development of programs and research of sexual education is important. The domestic elementary school needs advanced research, program, and textbook of sexual education to make our education more efficient. In order to achieve this, we need more supportive government policy. This study is based on the Education department of Republic of Korea's policy that makes young generation to understand the difference between male and female physically and psychologically so that they can be adaptive and responsible to society. This study was designed to help students of university of education to understand systematically about the content and domain of elementary sexual education. An on the job teachers, parents, and the school administrators are concerned with the essential of sexual education in elementary. However, there are actual issues fromm misunderstanding among the teachers that cause the narrow knowledge on sexual education to students. The domestic sexual education need continuous support to improve program that an on the job teachers and future teachers can use it for real.

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주민경,유경호,마효일,김윤중,김주용,송흥기,이병철 대한두통연구회 2004 두통 Vol.5 No.1