65세 이상의 노령층에서 고지혈증의 위험요인

김용배,장원기,황보영,김화성,안규동,이병국,이용진,김세훈,김승수,김승훈,김영록,김웅빈,이성수 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

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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.

납 노출 근로자들에서 ALAD 및 VDR의 다형질성이 조혈기능 지표에 미치는 영향

이성수,김남수,김진호,김용배,황보영,김화성,안규동,이병국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Objectives: This study was conducted with new workers who entered lead industries from 1992 to 2001 to evaluate the genetic susceptibility of ALAD (δ-aminolevulinic acid dehydratase) and VDR (vitamin D receptor) gene on health effect of lead exposure. Methods: Among the subjects of the database of lead industries at the Soonchunhyang University Institute of Industrial Medicine, only new workers were selected for this study. The total of eligible workers for this category was 3,540 workers, including non lead exposed workers of same lead industries. From stored blood in specimen bank of Soonchunhyang University, genotype of ALAD and VDR were measured using PCR method. Variables for this study were blood lead as an index of lead exposure, ZPP (zinc protoporphyrin in blood), urine ALA (δ-aminolevulinic acid), and hemoglobin as an index of hematopoietic effect of lead. Information on sex, job duration, and weight were collected for personal information. The data were analyzed using SAS (version 8.2) with descriptive analysis of t-test and multiple regression analysis. Results: Among 3,540 new employed study subjects during period of 1992-2001, 3,204 workers (90.5%) had ALAD genotype 1-1, while 336 workers (9.5%) had variant type of ALAD (1-2 or 2-2). For VDR genotype, 2,903 workers (89.7%) out of total tested 3,238 workers were belonged to type bb and 335 workers (10.5%) were type bB or BB. The distribution of genotype of ALAD and VDR were not different according to the job duration in male workers, but were different in female workers. The effect of ALAD and VDR genotype on blood lead were positively significant in the analysis of all cumulative data of new employed workers for 10 years. The effect of VDR genotype on blood lead were stronger than that of ALAD While the variant ALAD gene made decrease of mean ZPP and ALA in urine after controlling for blood lead and other covariate, the variant VDR gene made increased the mean ZPP and ALA in urine in all cumulative data analysis and cross sectional analysis by job duration. For hemoglobin, ALAD and VDR genotype did not affect the mean value. Conclusions: From the above our results, we found that ALAD and VDR genotype exerted significant effect in various way. We confirmed that the finding of a cross sectional study of protective effect of variant ALAD on the effect blood lead on blood ZPP in our retrospective study design. It was found that VDR did not exert protective effect for lead exposure as the variant ALAD did.

방사선치료 조사영역 내에 발생한 설암 환자에서 입체조형방사선치료 경험 : 증례보고

조문준,장지영,김기환,김병국,송창준,김준상,김재성 충남대학교 암공동연구소 2003 암공동연구소 업적집 Vol.3 No.

Objectives : We report an interim result of conformal radiotherapy in a patient with early stage cancer at the base of the tongue, which developed in a previously irradiated area. Materials and Methods : A 64-year-old male patient was diagnosed with T4NOMO supraglottic cancer. He received 72Gy of radiation therapy from 21 November 1988 to 24 February 1989. He had local failure and underwent a salvage total laryngectomy on 28 August 1989. Subsequently, he did well. In early 1999, he suffered from throat pain. He had a 2.5cm ulcerative mass at the base of his tongue, in the area that had been irradiated previously. Biopsy showed squamous cell carcinoma. After workup, he was diagnosed with base of tongue cancer with T2NOMO. Surgery was not feasible because the morbidity was not acceptable. Since it was difficult to re-irradiate the area with a curable dose using conventional 2D radiation therapy with an acceptable morbidity, we decided to try conformal radiotherapy. We used 7 static beam ports with field sizes from 7×6.4 to 8×8㎠, using 6 and 10MV photons. The fractionation regimen was 1.8Gy, 5 times per week. He received 64.8Gy in 36 fractions from 9 April 1999 to 1 June 1999. Results : In the 21 months since radiotherapy, the patient has not experienced any acute or chronic complications, such as xerostomia. He experienced relief of pain shortly after the start of radiotherapy, showed a complete response, and is still doing well. Conclusion : Conformal radiotherapy can be used to treat cancer that develops within a previously irradiated field, with curative intent.

방사선치료 조사영역 내에 발생한 설암 환자에서 입체조형방사선치료 경험 : 증례보고

조문준,장지영,김기환,김병국,송창준,김준상,김재성 충남대학교 암연구소 2003 암연구소 업적집 Vol.3 No.-

Objectives : We report an interim result of conformal radiotherapy in a patient with early stage cancer at the base of the tongue, which developed in a previously irradiated area. Materials and Methods : A 64-year-old male patient was diagnosed with T4NOMO supraglottic cancer. He received 72Gy of radiation therapy from 21 November 1988 to 24 February 1989. He had local failure and underwent a salvage total laryngectomy on 28 August 1989. Subsequently, he did well. In early 1999, he suffered from throat pain. He had a 2.5cm ulcerative mass at the base of his tongue, in the area that had been irradiated previously. Biopsy showed squamous cell carcinoma. After workup, he was diagnosed with base of tongue cancer with T2NOMO. Surgery was not feasible because the morbidity was not acceptable. Since it was difficult to re-irradiate the area with a curable dose using conventional 2D radiation therapy with an acceptable morbidity, we decided to try conformal radiotherapy. We used 7 static beam ports with field sizes from 7×6.4 to 8×8㎠, using 6 and 10MV photons. The fractionation regimen was 1.8Gy, 5 times per week. He received 64.8Gy in 36 fractions from 9 April 1999 to 1 June 1999. Results : In the 21 months since radiotherapy, the patient has not experienced any acute or chronic complications, such as xerostomia. He experienced relief of pain shortly after the start of radiotherapy, showed a complete response, and is still doing well. Conclusion : Conformal radiotherapy can be used to treat cancer that develops within a previously irradiated field, with curative intent.

조직구성 괴사성 림프절염의 임상적 고찰

김병국,이오영,김용민 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.2

Histiocytic necrotizing lymphadenitis(HNL) or Kikuchi-Fujimoto disease is a benign self-limited disorder and more common in Asians. Even though HNI, is a benignself-limited disorder, it has, on occasion, been misdiagnosed as malignant lymphoma. Authors evaluated 23 patients being diagnosed as HNL on excisional biopsy withretrospective chart review. Mean age was 25 years. female was predominant as male : female ratio 4 : 19. All patients manifestated cervical adenopathy. The next most common symptoms were fever(39%), sore throat(17.4%), fatigue(13%) and weight loss(13%). In 69.5%, there was involvement of cervical lymph node The lymph node site involved was, in orders, level 11(60.8%), V(52%), 111(39%), IV(34.7%). The spontaneous remission duration was 4-8 weeks, except 1 case that relapsed 6 months later. Laboratory findings revealed leukopenia(25%) and elevated ESR(75%). The microscopic findings on excisional biopsy was focal or diffuse necrosis with lymphocytes, histiocytes, nuclear fragments and fibrin deposits in paracortical area. Because HNL may be misdiagnosed as malignant lymphoma or other cervical adenopathy, excisional biopsy should be considered in young women with fever, multiple cervical adenopathy, leukopenia and elevated ESR, who were not responsive to antibiotics.

자기공명영상검사 환자의 폐쇄공포증에 관한 연구

김영수,이성수,안규동,이병국 순천향대학교 산업의학연구소 2001 순천향산업의학 Vol.7 No.1

When patients expose their body in closing or narrow space, they are afraid and are increasing heart rate and have a difficulty in breathing. The MRI examination could cause claustrophobia to patients because the patients keep their body into narrow space in MRI examination. In order to investigate the positive rate of claustrophobia symptoms according to several factors, such as, sex, age, examination time, examination part and purpose of examination, 330 patients(174 male, 156 female) were studied. The collected data was statistically analysis χ_(2)-test for categorical variables. Multiple logistic analysis was used to evaluated the effect of variables on discomfort feeling and claustrophobia symptom. 1. The rates of examination purpose were 51.2% by tumor or the other disease, 21.0% by traffic accident or trauma and 14.2% by headache, respectively. 2. The discomfort experience in connection with examination part was influenced by patients position and location in the Bore. The first time, the patient feel discomfort, was mostly when the examination was started(64.1%), so patients comfort position had to be maintained from examination starting time. The patients discomfort feeling was no relation with age and gender. 3. Over 50% of patients felt discomfort and 8.8% of patients did excessively discomfort and 2.8% of the patients could take MR examination because of discomfort feeling. The kinds of discomfort included the examination part pain(40.9%), the uneasiness(14.3%), the sense of oppression and uneasiness(12.2%) and the claustrophobia(12%). 4. Fourth decade's patients who had the claustrophobia symptoms were more than other decade's, and female patients(9.6%) had the claustrophobia symptoms more than male(6.9%). In the 330 of study subjects, the patients experienced the claustrophobia symptoms was 27 patients(8.2%). 5. Logistic analysis of the presence of discomfort feeling during MRI examination with categorized age and other selected categorized independent variables(sex, educational level, examination part, admission, number of examination, examination time, and the purpose of examination) indicated that age(<50 vs >60) and purpose of examination(tumor or military affair vs other) were significantly contributed to dependent variables with 95% significant odd ration confidence interval. 6. Logistic analysis of the presence of claustrophobia symptoms during MRI examination with categorized age and other selected categorized independent variables indicated that only Purpose of examination(tumor or military affair vs other) were marginally significantly contributed to dependent variables(p=0.07). 7 Most of study subjects revcaled similar opinion about the prevention of the claustrophobia symptoms, and the substitution plan included that the minimum of sound(98.9%), the enlargement of the bore(98.3%), the radiology technicians guidance and explanation(69.9%), listening the music or set up mirror(65.8%), the open-bore(47.5%) and the peaceful atmosphere(19.8%).

연작업자들에서 혈중 및 골중 연량과 조혈기능 지표 사이의 관련성에 ALAD 다형질성이 미치는 영향

김화성,이성수,김용배,황보영,리갑수,안규동,장봉기,이병국 大韓産業醫學會 2001 대한직업환경의학회지 Vol.13 No.1

목 적 : 혈중 연량 및 골중 연량과 조혈기능의 생화학적 지표사이의 관련성에 f-aminolevinicacid dehydratase 효소의 유전형질의 다형질성이 어떠한 영향을 주는지를 알아보고자 연작업자 450명을 연폭로군으로 연폭로가 없는 85명을 대조군으로 선정하였다. 방 법 : 조혈기능의 생화학적 지표로는 혈중ZPP, 요중 ALA, 혈색소 및 혈구용적치를 택하였고, 이들 상호관계에 영향을 줄 수 있는 교란변수로서 성, 연령, BMI, 흡연습관, 음주습관 및 연작업자들의 경우 연폭로 기간을 조사하였다. 결 과 : 동형유전형질인 ALADI을 가진 연작업자들은 407명으로 전체의 90.4 %이었으며, 대조군에서도 77명으로 전체의 90.6 %로서 양군간에 차이가 없었다.동형 유전형질을 가진 연작업자들보다 이형 유전형질을 가진 연작업자들의 골중 연량과 혈중 ZPP의 평균값이 적었으나 통계적으로 유의하지 않았고 나머지 연구변수들의 평균도 유전형질의 구분에 따른차이는 없었다. 성, 직력, BMI, 흡연여부, 음주여부 등의 흔란변수를 통제한 후 혈중 연량 및 골중 연량과 ALAD유전형질이 혈색소에 미치는 영향을 구한 바 혈중 연량과 골중 연량만이 혈색소에 유의한 영향을 주었을뿐 ALAD 유전형질은 유의한 영향이 없었다. 반면에 혈구용적치의 경우에는 혈중 연량과 골중 연량 그리고 유전형질 모두가 유의한 영향을 주지 못했다.요중 ALA를 종속변수로 하고 관련 혼란변수를 통제한 후 혈중 연량과 ALAD 유전형질 그리고 양자의 교호작용을 독립변수로 한 회귀분석들에서 혈중 연량 및 골중 연량과 ALAD 유전형질 모두가 주효과(main effect) 및 교호작용(effect modifies-tion)이 유의하석 이형 ALAD 유전형질을 가진 연작업자들의 ALAU가 동형의 유전형질을 가진 연작업자들보다 상대적으로 낮은 값을 나타냈다.혈중 ZPP를 종속변수로 하고 관련 혼란변수를 통제한 후 혈중 연량과 ALAD 유전형질 그리고 양자의 교호작용을 독립변수로 한 회귀분석들에서 혈중연량 및 골중 연량과 ALAD 유전형질 모두가 음의주효과(maln effect)가 나타나서 이형 유전형질의 연작업자들의 혈중 ZPP가 동형 유전형질의 연작업자보다 상대적으로 적은 값을 나타냈으나 교호작용(effect modification)은 없었다. 결 론 : 상기 결과로 미루어 ALAD 유전형질은 혈색소에는 유의한 영향을 주지 못했으나 ALAU 및 혈중 ZPP에는 유의한 영향을 주어 동형의 유전형질인 연작업자보다 이형의 유전형질 연작업자들이 상대적으로 낮은 ALAU와 혈중 ZPP값을 보여주어이형유전형질이 연에 보호효과가 있다는 가설을 돼받침하였다 Objectives : To evaluate the effect of ALAD polymorphism on the relationship of blood and bone lead with hematologic biomarkers in lead exposed workers, 450 lead exposed workers and 85 non-lead exposed workers were selected. Methods : Blood lead and tibia bone lead were selected as parameters of lead exposure and blood ZPP, urinary ALA (ALAU) , hemoglobin (Hb) and hematocrit (Hct) were chosen as parameters of hematologic effect of lead exposure. Genotype of each subject was assayed and expressed as ALADI and ALAD2. Demographic information such as sex, age and personal habit of smoking and drinking were collected. Job duration of lead exposed workers was also obtained. Results : The overall prevalence of the variant allele, ALAD2 in lead exposed workers was 9.6 %(43 out of 450 lead workers) which was not differed from control workers (9.4 % : 8 out of 85) . The means of tibial lead and blond ZPP in lead workers with ALAD2 were lower than those of lead workers with ALAD1, but the differences were not statistically significant. After adjusting for possible confounders (sex, job duration, BMI, drinking and smoking status) only blood lead and bone lead contributed negatively to the level of hemoglobin with statistical significance without any contribution of ALAD genotype. On the other hand, no significant effect of blood lead, bone lead and ALAD genotype were observed on the level of hematocrit after controlling possible confounder. ALAD genotype in the multiple regression analysis of blood lead fed bone lead with log transformed urinary ALA (LogALAU) after adjusting for possible confounders showed significant main and interaction effect on LogALAU simultaneously, which resulted lower LogALAU in lead exposed workers of ALAD2 than ALAD1. It was also observed only main effect of ALAD gene type on blood ZPP after adjusting possible confounder resulting lower ZPP in lead workers of ALAD2 than ALAD1. Conclusions : With above results, it was found that ALAD polymorphism did not affect on the level of hemoglobin and hematocrit, but ALAD polymorphism made significant effect on the association of blood and bone lead with urinary ALA and blood ZPP. The lower urinary ALA and blood ZPP in ALAD2 lead workers suggested that ALAD2 genotype may be supportive for the protective effect of lead.

톨루엔 폭로근로자의 요중 마뇨산과 자각증상에 관한 연구

김주자,함정오,안규동,이병국,남택승,백남원 大韓産業醫學會 1989 대한직업환경의학회지 Vol.1 No.2

To study the relationship between the urinary hippuric acid and subjective symptoms in toluene exposed workers, urinary hippuric acid was measured and subjective symptoms questionnarire was surveyed in 93 toluene exposed male workers and 96 non-exposed office male workers. The results are as follows: 1. Mean concentration of urinary hippuric acid, which is significantly higher in exposed group than in non-exposed group, was 1.3 g/1, 1.2(GM, GSD respectively) in exposed group and 0.6 g/1, 1.2(GM, GSD respectively) in non-exposed group. 2. Mean concentration of toluene in the air in the workplace, which is significantly higher in the department of coater than in the department of mexing, was 23.4 ppm, 6.2(GM, GSD respectively) in the department of mixing and 59.8 ppm, 3.4(GM, GSD respectively) in the department of coater. 3. Complained rates of subjective symptoms were significantly higher in exposed group than in non-exposed group in all items. 4. In exposed group, complained rate of CNS related symptoms was higher than that of irritation ralated symptoms in the first part but there was no significant difference and complained rate of irritation related symptoms in the second part was significantly higher than that of CNS related symptoms. 5. In exposed group, complained rates of subjective symptoms were not compatible with dose-response relationship by the concentration of urinary hippuric acid, duration of work, department of work, and age group retrospectively.

K X-ray 형광 기술을 이용한 골중 연량과 다른 연노출 지표들간의 관련성

김용배,이병국 순천향대학교 교수학습개발센터 2004 Journal of Soonchunhyang Medical Science Vol.10 No.3

Objectives: This study was carried out to assess bone lead in lead workers and to examine the relationship between bone lead and other lead exposure indices. Methods: The study design was cross-sectional and research subjects were 137 lead workers. General characteristics, smoking and alcohol drinking habit were obtained by self-administered questionnaire and history taking. Bone lead was measured using K X-ray fluoresconce technique. Blood lead(PbB), blood zinc protoporphyrin(ZPP), δ-aminolevulinic acid in urine(ALAU) were selected as indicators of lead exposure. Results: The mean of bene lead of lead exposed workers was 22.9±18.5 ppm. In univariate analysis, bone lead was associated with PbB and ALAU. After controlling confounding variables(age, work duration, body mass index (BMI), smoking and alcohol drinking habit), bone lead was statistically significant correlation with PbB and ALAU. Conclusion: Bone lead may be the best biomarker of cumulative dose in lead workers. Therefore, for the evaluation of lead workers in special health examination it is recommended the inclusion of bone lead measuremetn in addition to other lead exposure indices.