대장내시경검사의 전처치로서 항콜린제 사용에 관한 연구 : 전향적, 이중맹검법으로

박경남,한동수,이민호,최호순,박준용,손주현,이오영,함준수,전용철,송승찬,기춘석,윤병철,이종희 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Background: Use of antispasmodic medication prior to colonoscopy is controversial but someone believes antispasmodic may improve visualization of colonic mucosa and ease colonoscope insertion. So, we designed a study to assess the effect of premedication with the antispasmodic, hyoscine-N-butyl bromide(Buscopan') on the performance of colonoscopy. Methods: This study was prospective, double blinded, randomized, controlled study, One hundred three consecutive patients were randomized to receive intravenous buscopan lml(n=52) or placebo(n=51) combined with our standard initial medication(me- peridine 50 mg and midazolam 2 mg). Insertion of colonoscopy was timed, and 100 mm visual analogue scales (VAS) were used for asscssing difficulty of procedure, colonic motility, frequency of positional change, frequency of external compression, difficulty of assistance and degree of discomfort experienced by the patients. Results: There were no significant differences of intubation time between buscopan group(mean time, 7.23 min., range 2~15) and placebo group(7.07 min., range 3-25), (p=0.83) and withdrawal time between buscopan group (6.46 min., range 2-22) and placebo group(6.76 min., range 2 25), (p=0.69). Also, there was no significant differences in intubation time between males and females(buscopan; males 7.00 min., females 7.60 min., p=0.34, placebo; males 7.0~5 min., females 7.08 min., p 0.44). The VAS scores checked by endoscopist(p=0.29), assistant(p=0.32) and patient (p=0.15) were not significantly different in both groups. There were no significant differences in intubation time, VAS scores nf endoscopist, assistant, and patients. Conclusion: Premedication with intravenous bu.opan has no advantage on colonoscopy procedure. Use of antispasmodic medication prior to colonoscopy was not considered as recommendable agent.

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.

간질환환자의 위내용물 배출시간에 관한 연구

함준수(Joon Soo Hahm),이동후(Dong Hoo Lee),박경남(Kyung Nam Park),이민호(Min Ho Lee),이종철(Jong Chul Rhee),기춘석(Choon Suck Kee),유대현(Dae Hyun Yoo) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.2

N/A Gastric emptying time(GET) is influenced by several factors, such as neura), hormonal and composi- tion and physiochemical properties of food. The patients with delayed GET have some upper gastrointestinal symptoms such as recurrent nausea, vomiting, postprandia! Bloating, anorexia, and iveight loss. And also, almost of acute hepatitis and a part of chronic ]iver disease patients have similar symptoms of the patients with delayed GET. Therefore We performed GET measurement in liver disease patients to identify the relationship between nonspecific upper gastrointestinal symp- toms and gastric emptying function. The resu]ts are as followings; 1) Total ]iver disease patients are 28 in number, composed of acute hepatitis 3, chronic hepatitis 18, liver cirrhosis 7. 2) The GET(T1/2) of liver disease patients was delayed significantly than that of the normal volunteers. (Mean+SE;120.8+6.6 vs 89.4+5.9 mins.) 3) The GET of the symptomatic patients (N = 20 ) ivas 128.3+6.8 mins (Mean+SE), and that of the asymptomatic patients (N =8) was 101.8+13.2 mins. The symptomatic patients have delayed GET in 10 patients and asymptomatic patients have delayed GET in 3. 4) The GET of the patients who have elevated serum transaminase level higher than twice of normal is delayed significantly than that of the patients who have serum transaminase level lower than twice of normal. (Mean+SE; 143.4+2.6 vs 110.0+7.4 mins.)

거자법(巨刺法)에 의한 전침자극(電鍼刺戟)이 흰쥐의 formalin 유도(誘導) 통증(痛症)에 미치는 영향(影響)

박상균,김재효,김민선,박병림,손인철,김경식,Park, Sang-Kyun,Kim, Jae-Hyo,Kim, Min-Sun,Park, Byung-Rim,Sohn, In-Chul,Kim, Kyung-Sik 대한침구의학회 2000 대한침구의학회지 Vol.17 No.2

Acupuncture has been used for treatment of numerous diseases, especially for pain control in the oriental culture. However, the mechanism of pain control by acupuncture was not clear so far. The present study was examined that the effects of electro-acupuncture (EA) applied to the acu-point of extra-segmental area on modulation of formalin induced pain in Sprague - Dawley rats. In order to apply EA to acu-points in the plantar area of right fore paws, a pair of teflon - coated stainless steel wires were implanted in HT 7 (shin-mun) and PC 7 (dae-neong) 5 days before behavioral test. A behavioral test was performed by means of video camera after injection of 5% formalin ($50{\mu}l$) into the lateral plantar region of left hind paw. EA was delivered by a constant current stimulator at 4~5 mA, 2 ms, and 10 Hz for 30 min. The electromyographic activities were recorded in the biceps femoris muscle under chloral hydrate anesthesia. Test stimuli with 1~9mA were applied to the sural nerve territory including the medial portion of the 4th toe and the lateral portion of the 5th toe. Behavioral responses including favoring, flinching and bitting were occured in the biphasic pattern, such as the lst phase (0~5 min) and the 2nd phase (20~45 min) after formalin injection. However, EA (4~5 mA, 2 ms, 10 Hz) significantly inhibited Che behavioral responses. EMG activities of flexor reflex had a latency of 100~300 ms and thresholds of test stimuli for EMG were 4~5 mA in normal rats. Injection of formalin decreased threshold of test stimuli and increased EMG activities for 2hrs after injection. However, EA significantly inhibited EMG activities of flexor reflex increased by formalin and recovered EMG evoked thresholds. These results suggest that contralateral extra-segmental EA inhibits the first and second phases of formalin induced pain but their mechanism be needed to examine additionally.

치아이동에 의한 백서 삼차신경감각핵군내 c-Fos의 발현

민경호,박효상,배용철,성재현 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.3

이 연구의 목적은 말초조직에 유해 자극을 가하였을 때 중추 신경계내 이차 신경 세포체내에 발현되어 Neuronal marker로 사용되고 있는 c-fos를 사용한 면역 조직화학법으로 치아이동시 동반되는 동통의 투사경로의 이해에 도움을 주고자하는 것이다. 생후 9 주령의 210gm내외의 Sprague-Dawley계 웅성 백서 21마리를 교정력을 가하지 않고 마취만을 시행한 정상대조군과 교정력 적용 시간 경과에 따라 1시간, 3시간, 6시간, 12시간, 1일, 3일군으로 나누어 각 해당 시간동안 상악 우측 제1대구치와 상악 우측 측절사이에 Ni-Ti coil spring을 결찰하여 30gm내외의 지속적인 교정력을 가한 후 희생시켰다. 희생시킨 백서의 뇌간을 적출하여 토끼의 항체를 이용하여 면역화학 염색을 시행하였다. 삼차신경 감각핵군내 부위에 따른 c-fos 면역 반응 세포를 측정하여 교정력 적용 시간 경과에 따른 변화를 관찰하였다. · c-fos면역 반응 세포의 배측에서의 분포는 자극측 중위핵과 미측핵의 이행부위에서 시작하여 제1경추 척수 후각에까지 이어졌는데 가장 많은 분포를 보인 곳은 미측핵의 문측 부위였다. 그리고 주로 I층 과 II층에서 관찰되었다. · 복측에서의 c-fos 면역 반응 세포의 분포는 자극측 중위핵의 미측 부위에서 시작하여 미측핵의 중간부위에 까지 이어졌다. · 교정력 적용 3,6시간군에서 c-fos면역 반응 세포가 가장 많이 관찰 되었으며 12시간군에서 감소되기 시작하여 1일, 3일군에서는 현저히 감소 하였다. 위로 미루어 볼 때 지속적인 교정력에 의한 동통은 중위핵과 미측핵의 이행부위, 미측핵, 제1경추 척수후각에서 매개되는 것으로 생각된다. The c-fos is known as neuronal marker of second neurons which is activated by noxious peripheral stimulation. To investigate the changes of c-fos expression in the trigeminal nucleus complex during tooth movement, immunohistochemical study was performed. Experimental rats(9 weeks old, 210 gm, 21 rats) were divided into seven groups(normal, 1 hour group, 3 hour group, 6 hour group, 12 hour group, 1 day group, 3 day group). Rats in the normal group were anesthesized without orthodontic force. Rats in the experimental groups were applied orthodontic force (approximately 30 gm) to upper right maxillary molar. Frozen sections of brain stem were immunostained using rabbit antisera. The change of c-fos expression were observed with respect to rostrocaudal distribution, laminar organization, and duration of orthodontic force application. The study results were as follows. · The c-fos nuclei in the dorsal part were observed from ipsilateral transition zone of subnucleus interpolaris and subnucleus caudalis to C1 cervical dorsal horn rostrocaudally. The maixmal peak point was the rostral part of subnucleus caudalis. The greatest proportion of c-fos cells were located within lamina and I and II. · The c-fos nuclei in the dorsal part were observed from the most caudal part of subnuleus interpolaris to the middle part of the subnucleus caudalis. · The number of c-fos immunoreactive dot increased at 1 hour group, reached its maximum at the 3 and 6 hour groups, and showed a decreasing trend after 12 hours. These resutls imply that nociceptive stimulation caused by continuous orthodontic force might be modulated by transition zone of subnucleus interpolaris and subnucleus caudalis, subnucleus caudalis, C1 spinal dorsal horn.

5-〔3-(N-Substituted Piperazinyl)Propoxy〕Indan類의 合成과 中樞神經抑制效果

黃熙喆,閔庚鎭,文勝煜,李萬佶,徐丙天 嶺南大學校附設 基礎科學硏究所 1985 基礎科學硏究 Vol.5 No.-

Five new indans, 5-[3-(N-substitued piperaziny) propxy]indans, were synthesized by condensation of 5-(3-bromopropoxy)indan, the intermediate, and N-substituted piperazines. The structure of the compunds were determined by means of IR, NMR spectoscopy along with elemental analysis. Each compound was tested for antimorphine and antiamphetamine effects as part of CNS depressant effects and for muscle relaxant action in mice. Thes compound exhibited less potent activity compared to chlordiazepoxide on CNS depressant effect. Muscle reaxant action of the compounds, the side effect of tranquilizer, however, was much weaker than that of chlordiazepoxide.

삼일열 말라리아에 합병된 비장 파열 1예

홍경욱,이정아,김원진,박철민,권혜리,박혜원,엄중식 대한감염학회 2007 감염과 화학요법 Vol.39 No.5

국내의 토착형 말라리아는 삼일열 말라리아로, 1993년부터 재유행이 시작되었다. 말라리아의 중요한 합병증으로 드물지만 비장 파열이 있는데, 이는 주로 삼일열 말라리아에 의해서 발생되며, 국내에서는 1999년 말라리아에 의한 비장 파열로 비장 절제술을 시행한 예가 보고된 바 있다. 현재까지는 비장 파열이 있을 때 비장 절제술이 일차적인 치료로 되어 있으나, 비장 절제술 후의 감염 위험성이 크므로, 활력 징후가 불안정하거나, 출혈이 지속되는 소견이 보이지 않으면 가급적 보존적 치료를 하는 것이 추천된다. 저자들은 비장 파열이 동반된 말라리아 환자에서 비장 절제술을 시행하지 않고 보존적 치료로 호전된 예를 경험하여 보고하는 바이다. Plasmodium vivax has been the predominant Plasmodium species in the Republic of Korea and reemerged in 1993. Spontaneous rupture of malarial spleen is a rare but important complication associated with P. vivax infection. Only one case of spontaneous rupture of malarial spleen was reported in Korea in 1999. Splenectomy is still accepted as the treatment of choice in cases of spontaneous rupture of the spleen. But, considering increased risk of postsplenectomy infecion, splenectomy should be reserved for those patients with severe rupture or those with continued or recurrent bleeding. And conservative treatment should be considered in selected, closely monitored patients. We report a patient with P. vivax malaria who developed a spontaneous splenic rupture and was improved by conservative treatment.

겨울철 홍천강의 위생학적 수질조사연구

오덕철,김선균,주왕기,조동현,김우호,윤경민 江原大學校附設體力硏究所 1976 江原大學校附設體育科學硏究所論文集 Vol.- No.1

The water quality of the Hong-Cheon river was investigated during the winter season. The rate of contamination of the low tide was a little more than the high tide. But all values of the analyzed-items were similar to those in the clear water.

장기적 흡인 배액법을 이용한 척추 후방 기기 고정술 후 감염의 치료

김용민,김동수,최의성,손현철,박경진,김융성 충북대학교 의과대학 충북대학교 의학연구소 2003 忠北醫大學術誌 Vol.13 No.2

연구 목적 : 척추경 나사못을 이용한 척추 후방 기기 고정술 후 심부 감염이 발생한 증례 들을 대상으로 관련 인자를 분석하고 Hemo-vac을 이용한 장기간의 폐쇄성 흡인 배액법을 통한 치료와 그 결과에 대해 알아보고자 하였다. 대상 및 방법 : 1996년 5월부터 2001년 8월까지 척추후방기기고정술 후 심부 감염이 발생 한 5례를 연구 대상으로 하여 전신 질환 동반, 감염의 발현 양상을 조사하였고, 창상 세척 등 감염 수술 후 장기적 배액법을 이용한 치료 과정 및 최종 결과를 후향적으로 분석하였다. 결 과 : 당뇨와 비만이 술후 심부 감염의 위험요인으로 분석되었다. 수술 환부로부터의 배농, 발열 등 감염 증상은 술후 평균 18.8(8-36)일에 발현되기 시작하였다. 일인당 단 1회의 세척술이 실시되었고 고정기기는 제거하지 않았다. 이후 평균 19.2일간의 지속적 흡인 배농 및 평균 43.6일간의 항생제 정맥투여에 이은 평균 33.8일간의 경구투여로 심부감염은 특별한 합병증 없이 모두 치료되었으며 양호한 임상적 결과와 후외방 골융합을 얻을 수 있었다. 결 론: 척추 후방 기기 고정술 후 발생한 심부 감염에 대해 창상의 세척 및 육아조직 제 거 후 항생제 투여와 Hemo-vac을 이용한 장기간의 장기적 흡인 배액법은 감염의 조절과 척추의 안정성을 동시에 얻을 수 있는 유용한 방법중 하나인 것으로 생각되었다 Purpose: Various treatment modalities have been applied to control deep infection after spinal instrumentation. Validity of removing implants to control the infection is still contro- versial because it may cause loss of spinal stability. Analysis of the inherent risk factors associated with deep infection and the efficacy of management with long-term suction drainage without removal of implants. Materials and Methods : Fiye cases of postoperative deep infection after posterior spinal fixation from May 1996 to August 2001 were investigated on combined general ill- ness, features of infection, various profiles on the management of infection with surgical irrigation and debridement followed by long-term suction drainage, and final outcomes. Results :Remarkable risk factors were diabetes and obesity. Evidences of infection such as discharge from the wound, dehiscence, or fever were observed on the average of 18.8th day postoperatively By only one additional surgical procedure for each patient followed by long-term suction drainage for mean 19.2 days and administration of intravenous antibiotics for average of 43.6 days, deep infections were controlled successfully without removal of implants and without any grave complications. All achieved favorable clinical results and posterolateral fusion. Conclusion : Irrigation and debridement accompanied by long-term suction drainage using Hemo-vac and administration of susceptible antibiotics seemed to be one of the effective methods to control deep infection after posterior spinal instrumentation and main than the postoperative stability of spine.

Tourette 장애 소년에서 자기공명영상을 이용한 기저핵의 용적 분석

선우영경,신용범,이명지,김지영,배재남,강민희,김철응,이정섭 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.4

Objectives : The purpose of this study was to investigate the regional differences of the basal ganglia volume between the boy subjects who have Tourette's disorder and the control group who don't have this disorder by using Brain MRI. Methods : Sixteen subjects who were diagnosed as Tourette's disorder using DSM-IV criteria, and sixteen healthy subjects were selected. For analysis the coronal slice images of the basal ganglia were collected and collected MR images were analyzed with NIH Image (version 6.1 ppc). Resuls : The total brain volume in the subjects with Tourette's disorder were smaller than control group by 6.2% (F=6.2, d.f.=1, P=0.019). The right putamen volume in boys with Tourette's disorder were significant smaller than control group statistically (F=3.2, d.f.=3, P=0.040). The asymmetry (1eft>right) in the globus pallidus decreased significantly in the boys with Tourette's disorder (p=0.06) were found from this experiment. Conclusion : These findings suggest that boys with Tourette's disorder may have neuropathological abnormalities in the basal ganglia. Moreover, the present findings point out the important role of basal ganglia, especially putamen, in Patho-physiology of Tourette's disorder. More studies about the structural and functional analysis of the basal ganglia in Tourette's disorder are highly required.