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.

[18F]FDG PET을 이용한 강박증 환자에서 뇌 포도당 대사의 이상에 관한 연구

권준수,이동우,이재성,최정임,이동수,정준기,조맹제,이명철,류인균 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 강박증에 대한 기능적 뇌영상 연구들에서 강박증 환자들의 안와전두엽과 미상핵의 대사율 증가 소견이 비교적 일과되게 발표되어 왔으며, 전두-피질하 회로의 이상이라는 이론이 수립되기도 하였다. 그러나 기존의 연구들은 강박증의 유병기간에 따른 구분없이 시행된 연구였고, 영상분석 방법에 있어서도 관심영역 방법을 이용했다는 한계를 지니고 있다. 본 연구의 목적은 첫째, 강박증의 유병기간에 따라 환자군을 구분하여 PET 영상소견을 분석함으로써 유병 기간에 따른 차이가 있는지를 조사하였으며, 둘째, 강바증 환자의 포도당 양전자방출 단층촬영(18-Fluor-deoxyglucose Positron Emission Tomography : FDG-PET) 영상분석에 통계적 매개변수 지도법(Statistical Parametric Mapping : SPM)을 이용함으로써 강박증의 병인기전 및 강박증상과 뇌기능 간의 관계를 명확히 규명하고자 하였다. 방법: 구조적 면담도구(Structured clinical interview for DSM-IV : SCID-IV)를 적용하여 진단된 12명의 강박증 환자들과 10명의 정상 대조군에 대해 FDG-PET을 촬영하여 SPM으로 분석하였다. PET 촬영 전 적어도 4주 동안에는 약물복용을 하지 않은 상태였다. 결과: 1) 환자군과 대조군의 비교 : 강박증 환자군은 대조군에 비해 양측 두정 영역의 대사율이 유의하게 감소되어 있었으며(P<0.01). 대사증가를 보인 영역은 없었다. 강박증의 유병기간이 10년 이상인 만성강박증 환자 4명은 양측 안와전두엽에서 유의한 대사증가 소견을 보였으며(P<0.01), 양측 두정영역에서 유의한 대사감소 소견을 보였다 (P<0.01), 유병기간이 10년 이하인 환자에서는 전체 환자군의 분석에서와 마찬가지로 대조군에 비해 유의한 대사증가 소견을 보인 영역은 없었으며, 양측 두정엽 부위에서 유 의한 대사 감소 소견을 보였다.(P<0.01). 2) 강박증상의 심각도와의 상관관계 분석 : 우측 두정엽의 대사율은 강박장애 척도 점수와 유의한 음의 상관관계를 보였으며(p<0.01), 양측 시상 영역의 대사율은 예일-브라운 강박장애 척도의 강박장애척도 점수와 유의한 양의 상관관계(p<0.01)를 보였다. 결론: 본 연구는 결과는 기존의 연구들에서 보고된 안와전두엽의 대사 증가 소견이 강박증의 만성화로 인해 나타나는 2차적 장애이며, 두정엽의 대사 저하가 보다 1차적인 장애일 가능성을 시사한다. Baxter가 수립한 전두-피질하 회로 이론은 두정엽의 이상을 포함하는 전두-두정엽 복합체 이론으로 확장되어야 할 것이다. Objectives: Functional imaging studies on obsessive-compulsive disorder(OCD) subjects have repeatedly reported increased metabolism in orbitofrontal lobes and caudate nucleus, resulting in the "frontal-subcortical" circuit abnormality theory. Limitations of the previous studies to date include little consideration for the duration of illness, and the use of regions of interest methods, as an image analysis method. Our study objectives are 1) to include the duration of illness as an important study variable, and 2) to use Statistical Parametric Mapping(SPM) method in order to tap relations between the brain function and the psychopathology and symptoms of OCD. Methods: The [18] fluorodeoxyglucose positron emission tomography(FDG-PET) scans of OCD subjects and normal comparison subjects, as diagnosed by the Structured Clinical Interview for DSM-IV(SCID-IV), were analyzed using SPM. Results: 1) Comparison of OCD and control groups : OCD subjects had significantly decreased metabolism in both parietal lobes and didn't have any areas of increased metabolism in comparison to comparison subjects(p.<0.01). four OCD subjects with the illness duration of 10 years or longer, had significantly increased metabolism in both orbitofrontal lobes<p<0.01). OCD subjects whose illness duration is shorter than 10 years didn't have any areas of increased metabolism and had significantly decreased parietal lobe metabolism, as in the analyses of all subjects(p<0.01). 2) Correlation analysis between areas and symptom severity : Metabolism of both thalamic sreas showed significant positive correlation with Yale-Brown Obsessive-Compulsive Scale(Y-BOCS) scores(p<0.01). Metabolism of right parietal area showed significant negative corre lation with Y-BOCS scores(p<0.01). Conclusions: The current findings suggest that the increased metabolism in orbitofrontal lobe, previously rported, may be a secondary phenomenon due to the extended illness dur- ation and that decreased metabolism in the parietal lobes are primary abnormality in OCD subjects. Thus Baxter's fronto-subcortical circuit theory should be extended into "fronto-pari-etal" complex theory, which includes the parietal lobes.

양전자방출단층촬영을 이용한 초점주의와 작동기억의 뇌 활성화 양상 비교

김재진,조상수,김명선,손정우,이재성,이동수,이명철,권준수 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.2

연구목적: 단순 초점주의 과제와 보다 고도의 집중을 요하는 작동기억 과제를 수행하는 동안의 뇌 활성화 양상을 비교하여, 두 인지기능 과정을 매개하는 정상적 신경회로의 특성과 차이를 알아보는 것을 목적으로 하였다. 방법: 정상인 14명을 대상으로 시각처리 대조 과제, 단순 초점주의 과제, 작동기억 과제 등 세 가지 인지과제를 주고, 과제 수행 동안 [□O]H₂O를 추적자로 한 양전자방출단층활영을 실시한 후 감산분석을 통해 초점주의와 작동기억의 신경회로 지도를 작성하여 비교분석하였다. 결과: 초점주의 동안 활성화되는 부위는 좌측으로 편측화되고 산발적으로 분포하는 양상이었고, 특히 전대상이랑과 운동영역을 포함한 전두엽, 일차 및 이차 시각피질 등의 활성화가 특징적이었다. 작동기억 동안의 뇌 활성화 역시 산발적 분포와 좌측 편측화 양상이 관찰되었으나, 시각피질보다는 전두엽의 활성화가 우세하였고, 특히 우측 전대상이랑의 현저한 활성화가 특징적이었다. 결론: 초점주의와 작동기억은 개념적으로 공통점과 차이점을 내포하고 있는 것처럼 매개 신경회로에서도 공통 혹은 특이한 영역을 각각 가지며, 전대상이랑의 역할이 두 기능에 공통적으로 중요하고, 이차 시각피질과 전전두피질이 두 기능 각각에 더 중요하게 작용하는 것 같다. Objectives:This study was undertaken to identify neural substrates for simple focused attention and more highly-focused working memory i normal people and investigate their characteristics and differences. Method: Fourteen normal subjects were studied with [□O]H₂O positron emission tomography during a visual processing baseline task, simple focused attention task and working memory task. Results were analyzed with the subtraction analysis to map the neural correlates of focused attention and working memory. Results: Activated areas during focused attention tended to be lateralized to the left and scattered over various regions including the anterior cingulate, motor area, and primary and secondary visual cortices. While the areas activated during working memory also show the left lateralization and scattered distribution, activation prevailed more in the frontal lobe than in the visual cortex, and was particularly remarkable in the right anterior cingulate. Conclusions: Focused attention and working memory do not have only conceptually commonalities and differences but also have common and specific areas in their neural substrates. The anterior cingulate may commonly play an important role in both cognitive functions, whereas secondary visual cortex and prefrontal cortex seem to be predominantly implicated in each function, respectively.

부산 경남지방에 발생한 쭈쭈가무시병 64예의 임상적 고찰

이상훈,전명호,신병철,박기찬,김영효,배성,전광수,김종성 동아대학교의과대학 1992 동아의대학술지 Vol.4 No.1

구강외과 수술용 스텐트 기반 영상유도 수술 시스템의 개발

이우진,김대승,이원진,이삼선,최순철,허민석,허경회,김명진,이지호 대한구강악안면방사선학회 2009 Imaging Science in Dentistry Vol.39 No.3

Purpose : The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. Materials and Methods : We devised a patient-specific stent for patient-to-image registration and navigation. Threedimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. Results : The accuracy over 8 anatomical landmarks showed an overall mean of 0.56±0.16 mm. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. Conclusion : The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites. (Korean J Oral Maxillofac Radiol 2009; 39 : 149-56)

기도분비물에 의한 기관 내 튜브의 부분 폐쇄

이상준,이동준,김문철,임의재,김명화 인제대학교 2009 仁濟醫學 Vol.30 No.-

During anesthesia, unexpectedly endotracheal tube obstruction cause seriouscomplications which require early diagnosis and immediate management. Endotracheal tube obstruction with foreign body is rare. 74 year old man was scheduled for open lung biopsy. The patient was intubated with a 7.5 mm reinforced endotracheal tube and turned to the right lateral position. After 30 minute, signs of partial endotracheal obstruction was observed including high airway pressure and decreased end-tidal CO2. A suction catheter was not deeply advanced. A wheezing - like sound was heard. We temporarily stopped the operation and turned the patient to supine. We exchanged the tube with another one and found impacted mucous secretions at the distal tip of the tube.

영유아예방접종시 보건소이용가정과 병의원 이용가정의 사회계층적 특성에 관한 분석연구

李恩珠,李明淑,車喆換 고려대학교 의과대학 1991 고려대 의대 잡지 Vol.28 No.3

In order to develop an appropriate health care service program for a population. it is of utmost importance that the particular population's demograhic and socio-economic characteristics are taken into consideration. The purpose of this research was to determine which of the demographic and socio-economic factors gathered from basic family health records contribute to the decision by people to use either the hospitals and clinics. or health centers for their children's health care. The target area of this study was Guro 6 dong. Guro-Ku, Seoul. A sampling method of choosing families whose children(1-3 years old) had already received their third DPT vaccination resulted in 405 subject familes out of 3904 family health records which were on file at the Guro 6 dong health subcenter A general survey of the households under study revealed that 61.9% of the children received the vaccinations at a health center. and 38.1%. at a clinic or a hospital. The demographic. socio-economic. and maternal health behaviour characteristics were all analyzed for each of the 405 families. In addition. the likelihood of each family to use either the clinic and hospital or the health center was analyzed. Significant differences in the data were determined by the Chi-squared methcd. The factors affecting the utilization of medical facilities ware examined through a stepwise discriminant analysis. using the type of medical facility utilized as group variable, and the demographic characterlistics socio-economic characteristics. or maternal health behaviour as discriminant variable. 1. Of the demographic characteristics. father's education. the mother's age. mothor'education. and the mother's occupation had a hit ratio of 58.0% 2. Upon the analysis of socio-economic characteristics, type of housing, status of ownership of the house, household income, and whether the family had a telephone had a hit ratio of 69.9%. 3. Using maternal health behaviour. as the discriminating variable, and prenatal care, postpartum care had a hit ratio of 70.9%. 4. The stepwise discriminant analysis resulted in postpartum care, type of housing, ownership status of the house, mother's occupation, monthly income, and ownership of telephone having a hit ratio of 73.4%. The collection of basic health information of a population is essential for planning an appropriate health care service program. This research has shown that, as part of the basic information, demographic, and scoio-economic, as well as maternal health behavior characterisics are very important in determinizing an individual's preference for a particular type of medical facility from the available ones. Furthermore, these specific characteristics of a population may be used in planning a comprehensive health care service program to make certain appropriate facilities and programs are available. More need to be done in the future to discover the factors which influence the effective utilization of health service programs available to the population.

혼합치열기 어린이에서 Streptococcus mutans와 Streptococcus sobrinus의 분포도 조사

이명성,최성철,박재홍 대한소아치과학회 2007 大韓小兒齒科學會誌 Vol.34 No.2

본 연구는 125명의 6-11세 혼합치열기 아동을 대상으로 연령에 따라 초기 혼합치열기 A군(6-8세; 62명)과 후기 혼합치열기 B군(9-11세; 63명)으로 분류하고 유치의 dfs, 영구치의 DFS를 기록한 후 자극성 타액을 채취하여 TYCSB 배지에 배양해서 S. mutans와 S. sobrinus를 구분하였으며 PCR을 시행하여 확인하였다. S. mutans와 S. sobrinus의 분포도와 치아우식증과의 상관관계를 조사하여 다음과 같은 결과를 얻었다. 1. S. mutans와 S. sobrinus의 상관계수는 A군 0.70, B군 0.50로 두 군 모두에서 높은 상관관계를 보였다. 2. S. mutans와 치아우식증과의 관계는 A군(r=0.25)과 B군(r=0.34) 모두에서 약간의 관련성이 나타났다. 3. A군에서 S. sobrinus와 치아우식증간에 상관관계가 없는 것으로 나타났으며, B군(r=0.21)에서는 미약한 상관관계가 성립되었다. 4. S. mutans와 나이의 상관관계는 A군과 B군 모두에서 관련성이 없는 것으로 나타났다. 5. S. sobrinus와 나이의 상관관계는 A군(r=0.32)에서는 약간의 관련성이 나타났고, B군에서는 관련성이 없는 것으로 나타났다. Mutans streptococci have been reported to be implicated in dental caries. Of these streptococcal species, Streptcoccus mutans and Streptococcus sobrinus are most commonly found in human dental caries. Prevalence of these bacterial species in dental caries is found to be varied in different races and countries. Therefore, importance of these bacteria in dental caries remains to be determined. The present study was performed to find out correlation S. mutans and S. sobrinus with dental caries in 125 Korean children with mixed dentition between 6 to 11 years of age. They were classified as group A(6-8 years) and group B(9-11 years) by age. For the study, stimulated saliva samples were collected from each subject. The vials containing saliva specimens were serially diluted (1:10) in saline and plated in duplicate on tryptone-yeast extract-cysteine with sucrose and bacitracin (TYCSB) for S. mutans and S. sobrinus. After genomic DNA was extracted from the samples, polymerase chain reaction (PCR) amplification was performed for identification using universal primers and specific primers to S. mutans and S. sobrinus. Data of microbial variables were compared to caries status of the subjects. According to this study, the result were as follows: 1. S. mutans versus S. sobrinus were moderate positive linear correlated in both group A(r=0.70) and group B(r=0.50). 2. Between S. mutans and dental caries, there were weak positive linear correlation in both group A(r=0.25) and group B(r=0.34). 3. S. sobrinus versus dental caries were not correlated in group A but slightly correlated in group B(r=0.21). 4. Between S. mutans and age, there were not correlation in both group. 5. S. sobrinus versus age were weak correlated in group A(r=0.32) but not correlated in group B.

생쥐 대장 평활근 세포에서 내향 정류성 칼륨 전류의 특성 연구

이은주,김명,정명섭,조향훈,김기훈,하현철,김준수,최석,전제열 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2

Objectives: K^(+) channels play an important role in regulating cellular excitability. The aim of this study was to know whether or not inward rectifier K^(+) channel exists in colonic smooth muscle cells. Methods: Mouse colonic smooth muscle cells were isolated using collagenase, and then we recorded their membrane currents using a whole-cell patch clamp technique. Results: With 90 mM K^(+) in bath, hyperpolarization-induced inward currents from -120 mV to 20 mV with 400 ms duration at a holding potential of -10 mV showed rapid activation, inactivation and inward rectification. The inactivation showed single exponential time course. Reduction of external K^(+) to 60 mM decreased the amplitudes of the currents in whole test voltage range and shifted the reversal potential to more negative potential. The inactivation process and peak currents of hyperpolarization-induced inward currents were not affected by removing external Na^(+). External Ba^(+) blocked hyperpolarization-induced inward currents by dose-dependent manner and pure Ba^(+)-sensitive currents showed strong inward rectification. Cs^(+) also suppressed hyper- polarization-induced inward currents. Ba^(+) and Cs^(+)-induced inhibitiOn of hyperpolarization-induced inward currents was voltage-dependent, and the extent of inhibition increasing with membrane hyperpolarization. Conclusions: These results suggest that inward rectifier KU channels may exist in proximal colonic smooth muscle and may play an important role in regulating membrane potential.

GIS를 이용한 산불발생위험지역 구분

이시영,안상현,원명수,이명보,임태규,신영철 한국지리정보학회 2004 한국지리정보학회지 Vol.7 No.2

산불로 인한 재해를 미연에 방지하고 피해를 저감하기 위해서는 산불발생위험지역을 사전에 파악하여 예방대책을 세울 필요가 있다. 따라서 본 연구에서는 산불발생인자에 따른 산불발생위험지역을 구분하고자 겸상북도 의성군에서 발생한 산불피해지역에 대하여 임상, 지형 등에 대하여 조사하였다. 조사된 요인들 간 독립성 유무를 상관분석을 이용하여 산불발생과 관련 있는 7개의 주제도를 선정하였으며, 선정된 주제도를 조건부확률과 지리정보시스템을 이용하여 산불발생확률을 계산하였다. 계산된 산불발생확률을 20개 등급으로 지수화하여 산불발생위험지역을 구분하였다. In order to decrease the area damaged by forest fires and to prevent the occurrence of forest fires, we are making an effort to improve prevention measures for forest fires. The objective of this study is to classify hazard regions where forest fires occur based on the factors that contribute to the occurrence of forest fires. Forest fire sites in the Uiseong-gun, Gyeongsangbuk-do were surveyed according to the factors of forest type and topographic characteristics where the forest fires occurred. We used a correlation analysis to determine the forest fire occurrence factors and a conditional probability analysis and GIS to determine a forest fire danger index. The resulting forest fire danger index was used in the classification of forest fire occurrence risk regions.