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.

대구 상인동 가스참사로 본 지역 응급의료체계에 대한 고찰

이삼범,도호석,도병수,이창현,심민철,권굉보 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Disaster may be defined as a sudden calamitous event associated with great damage or destruction. A more common definition, among emergency-preparedness planners, is a medical occurrence that overwhelms medical care systems and facilities. Most regional disaster plans are formulated to respond to disasters of moderate size. At 07:50 A.M. on 28 April 1995, gas explosion was happened at Sangin-Dong where was going to be under construction of subway in Taegu, Korea. 102 victims had died and 178 victims had moderate or minor injuries. Problems in the organization at the scene, triage, field management, transport to the hospital, and the communication contributed to the confusion in the management of victims. An analysis of this disaster allows several lessons to be learn about perimeter control, command functions, crowd control, and transportation priorities. It will benefit disaster planners in other communities.

응급의학과에서의 인공호흡기 처치

이삼범,도호석,도병수,이창현,심민철,권굉보 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Study Objectives : To investigate and resolve the problems related with ventilator management in ED(emergency department). At present the ventilator is essential equipment of ED on university hospital and emergency center in Korea. Design : Retrospective consecutive case series. Setting : University teaching hospital Type of participants : All patients admitted and recieved ventilator management in ED of yeungnam university hospital from Jan. 1994 to jul. 1995. Methods and interventions : Charts of all patients were reviewed to determine the frequency, the types and causes of respiratory failure, the death rate, the mean duration of admission, the complications, and CPR(cardiopulmonary resuscitation) related with ventilator management in ED. We also identified the problems related with ventilator management by ED physicians and nurses through the answers to seven questions that suggested by us about ventilator management in ED. Measurements and main result : There were 34,751 admissions through ED during the study period. Of these 160 patients managed with ventilator in ED. The frequency of ventilator management in ED is increased at 1995(0.73%) that compared with 1994(0.32%). Non-trauma(113 cases) and hypoxic respiratory failure(83 cases) patients are more common than trauma(37 cases) and ventilatory failure Total CPR rate related with ventilator management are 25.3%. The mean duration of admission are 12.56±20.28 days, and the death rates are 45.3%. The incidence of complications occurred during ventilator management in ED are 37 cases. About seven questions suggested by us to 30 ED staffs(ED physician, nurses and paramedics), most frequent answer is the difficulty of keeping ventilator in ED because other department rent ventilator from ED and lost a part of ventilator. Conclusion : As the use of ventilator in ED is increased the emergency physician should be well trained for the indications, complications, setting mode and general problems of machine occurred during ventilator management in ED patients.

경련성 복통을 호소한 급성 간헐성 포르피리아증 1례

이창현,도호석,이삼범,도병수 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Acute intermittent porphyria(AIP) is a genetic disorder of heme biosynthesis caused by defects in the gene encoding hydroxymethylbilane(HMB) synthase on the long arm of chromosome 11, and is characterized by overproduction, accumulation and excretion of heme precursors. The common symptoms of AIP are neurovisceral symptom and abdominal pain is most common symptom, therefore attacts are often confused with acute abdomen or bowel obstruction. Thus AIP is rare disorder, but when other disease is ruled out, some consideration is needed especially in emergency department. In conclusion, the authors report a case of AIP that complained of the cramping abdominal pain with the review of literatures.

Equaatiorial-Skew [Co(TRDTRA)(OH₂)] 착물과 CN, NO₂그리고 NCS 이온간의 치환반응

都命基,趙榮在,李東鎭,吳昌彦,金東曄 嶺南大學校 基礎科學硏究所 1992 基礎科學硏究 Vol.12 No.-

Equatorial-Skew형[Co(TRDTRA)(OH₂)]착물과 ??,?? 그리고 ?? 이온 간의 치환반응결과 생성된 차물의 치환반응성 및 구조를 전자흡수 스펙트럼과 Yamatera 이론에 따라 조사하였다. 속도론적 자료로부터 착물과 ??,?? 그리고 ?? 이온의 반응차수는 각각 1차이며 총괄 반응차수는 2차임을 알 수 있었다. ?? 및 ?? 이온에서 생성된 착물의 구조는 이성질화 반응이 동반된 Polar-Chair 형이며, ?? 이온의 경우에는 이성질화 반응이 동반되지 않은 Equatorial-Skew 형임을 알 수 있었다. The substitution reaction and structrue of products obtained from the reaction of Equatorial-Skew-[Co(TRDTRA)(OH??)](TRDTRA=trimethylenediaminetriacetate) with ??,??, and NCS ions have been investigated by means of electronic absorption spectroscopy and theoretical calculation based on the Yamatera`s theory. According to kinetic data, the substitution reaction order for the complexes such as ??,?? and ?? was the first order, respectively, and overall reaction order was second order. It has been determined that the structure of products having ?? and ?? ions was Polar-Chair type complexes which were accompanying with isomerization and having ?? ion was Equatorial-Skew type complex which was not accompanying with isomerization.

급성흉통으로 내원한 환자에서 심근경색증을 조기 발견하기 위한 TROP-T?Rapid Assay의 유용성

정준영,이창현,김현정,도호석,이삼범,도병수 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Study Objectives : In the past, measurement of cardiac enzymes(i.e. CK and/or CK-MB, GOT, LDH)and myoglobin, cardiac specific serum troponin-T were widely used for the diagnosis of acute myocardial infarction, but it need a long time and have low specificity. Thus new diagnostic modality, TROP-T?? Rapid Assay, is very easy and rapid qualitative methods, is needed for the early detection of acute myocardial infarction. Methods : Total CK, GOT, LDH, myoglobin and serum troponin-T activities were measured in patients presenting with acute chest pain at the emergency department and at the same time TROP-T? Rapid Assay was done. Final diagnosis and diagnostic usefulness was evaluated. Results : Overall diagnotic sensitivity and specificity of initial results were as follows; TROP-T? Rapid Assay, 77.3, 100.0; myoglobin, 63.6, 70.4; CK, 95.5, 96.3; GOT, 86.4, 96.3; LDH, 90.9, 92.6; serum troponin-T, 86.4, 96.3, respectively. Conclusion : The TROP-T?? Rapid Assay is simple method and has a short time and nearly same sensitivity and specificity compared to other cardiac enzymes. Thus this is considered useful method in the early detection of acute myocardial infarction at emergency department.

외상성 간손상과 비장손상시 CT분류의 의의

정준영,이창현,김현정,도호석,이삼범,도병수 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

The Organ Injury Scaling Committee of the American Association for the Surgery of Trauma recently published a consensus classification of hepatic and splenic injuries. The hepatic and splenic injury scales, based on parenchymal laceration and intrahepatic hematoma, include grade 1 to 6 and grade 1 to 5 respectively, representing the least to most severe injury. Forty-eight patients with hepatic and splenic injury were evaluate by abdominal CT from January 1995 to May 1996 and we compared abdominal CT grading with operative grading. Four CT grades did not correlate with operative finding. CT grading showed a sensitivity of 80%, specificity 80% in regard to operative grading. We conclude that 1) CT is an accurate technique to determine the extent of hepatic and splenic injury. 2) CT grading of hepatic and splenic trauma has a high correlation with operative grading.

2인과 3인의 기본 심페소생술 비교

정준영,이창현,김현정,도호석,이삼범,도병수 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

Study objectives: To compare the quality of CPR provided by medical students and pre-EMTs perfoming three-rescuer CPR with that achieved by same students trained to provide standard two-rescuer CPR and to find the most effective method of resuscitation and to educate this methods to students. Material and methods: From July 1 to September 30, 1996, we had trained 60 groups consisted of the medical students, students of EMS technology and pre-EMT. Each group practiced two-rescuer CPR and three-rescuer CPR for 120 minutes with Resusci? Anne and perfomed CPR for at least 3 minutes without feedback. To eliminate any visual cues of perfomance the mannequin's recorder was hidden. Each actions were recorded by Resusci? skillmeter and Laerdal printer. To compare the quality of two-rescuer CPR and three-rescuer CPR, we analyzed the data by SPSS with paired t-test. Results: Three-rescuer teams delivered a mean minute ventilation and a mean minute cardiac compression substantially greater than that produced by two-rescuer teams(11.30±1.85 vs 9.09±2.22, p<0.001; 99.22±12.42 vs 95.12±15.75, p<0.001). Three-rescuer teams produce the more correct actions in chest compression and ventilation(93.84±7.56% vs 83.49±16.94%, 90.90±9.33% vs 77.00±17.06%). Conclusion: Three-rescuers can produce better CPR than two rescuers when a bag-valve-mask devices is used and the technique is easily learned and readily retrained, so we think that repeated education and training of this CPR methods to students is needed.

조선대학교 의과대학 의학과 학사편입제도의 전향적 검토

임성철,박상기,도남용,박상학,이승일,송창훈,박종 朝鮮大學校 附設 醫學硏究所 1998 The Medical Journal of Chosun University Vol.23 No.1

There are many advantages and disadvantages under the limited bachelor's admission system. To diminish the demerits and to increase the merits of this system, the authors posed questions to the faculties and students of the Department of Medicine. Chosun University College of Medicine and other colleges in Korea. The questionnaire was made according to trends and feelings in this system. We received a lot of information and suggestions as to how to improve the system, in the following paper we discuss and report the prospective aspects of the bachelor's admission system.

조선대학교 의과대학 의학과 학사편입학제도의 전향적 검토

임성철,박상기,도남용,박상학,이승일,송창훈,박종 조선의대 1998 The Medical Journal of Chosun University Vol.23 No.1