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.

국내 주요호수의 육수학적 조사 (1) : 옥정호

김범철,박주현,이병진,허우명,황길순,최광순,채기숙 江原大學校 附設 環境硏究所 1998 環境硏究 Vol.15 No.-

The limnological survey of Lake Okjong was conducted for one year from June 1993 to May 1994 on the monthly basis. The loading of phosphorus, nitrogen and organic carbon from the watershed into the lake were monitored at the main in flowing sites. Secchi disc transparency , epilimnetic chlorophyll a, total nitrogen, total phosphorus concentration and primary production were in the range of 1.3~4.H m, 2.4~ 18.7 mg Chl/m³. 1.25~2.87 mg N/l, 7~65 mg P/m³, 325~2,113 mg C/m²/day, respectively. TN/Tl atomic ratio varled from 129 to 443. N/P ratio decreased in summer because phosphorus concentration was higher than in winter, while nitrogen did not vary much. The seasonal succession of phytoplankton was distinct. In winter and spring, diatoms, Aulacoseira granulata var. angustissima and Aulacoseira italica were dominant while cyanobacteria, Microcystis sp.,M. ichthyovlabe, Phormidium sp. and P.valderianum var. tenuis were dominant in warm seasons. The dominant zooplankton species were Thertmocyclops taihokuensis in warm seasons while Boosmina longirostris were dominant in cold seasons. The organic carbon, nirtogen and phosphorus content of lake sediment were 8.0~14.8, 0.59~0.71, 1.14~1.87 ng N/g, respectively. The sediment of Lake Okjong can be classified as oligohumic based on C/N ratio. The total phosphorus loading from the watershed and fishfarm were estimated to be 2.7g P/m²/yr, which far exceeded the critical loading for eutrophication. The organic carbon loading from the watershed and primary production were determined to be 998t C/yr, 6,348t C/yr, respectively. Most of organic carbon was contributed by autochthonous primary production of phytoplankton. Trophic state of Lake Okjong can be classified as eutrophic

유기용제 폭로가 여성 근로자들의 월경에 미치는 영향

김대환,이채관,김휘동,강동묵,문덕환,김정호,손병철,이창희,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1

유기용제는 산업장에서 널리 사용되고 있다. 특히 여성근로자들의 폭로기회가 증가하고 있으며 이로 인한 자연유산, 수태능력 감소, 월경이상 등이 보고되고 있다. 따라서 유기용제 폭로가 여성근로자들의 월경에 미치는 영향을 보기 위해 설문조사와 월경주기별 여성생식 호르몬(progesterone, estrogen) 분석을 하였다. 그 결과 폭로군에서 progeterone의 억제효과가 유기용제에 폭로되는 여성근로자들의 다양한 월경이상을 초래할 가능성이 있는 것으로 생각된다. ■ Objectives This study was conducted to evaluate the effects of menstrual function in female workers exposed to organic solvents. ■ Methods Rates of menstrual disorders were studied in 87 female workers with exposure to organic solvents(Cn/Hn-value 0.713) in a factory manufacturing shoes and compared with 83 general female workers who had no exposure to organic solvents, Detailed menstrual and reproductive histories were obtained by personal interview using structured questionnaire, and plasma concentrations of progesterone and estrogen were assayed by radioimmunoassay(RIA). ■ Results The rates for menstrual irregularity, menstrual duration, blood clot in menstrual flow and dysmenorrhea were not significantly different in both groups. Number of using menstrual pad was significantly higher and the plasma level of progesterone during 6-11th day of menstrual cycle was significantly lower in the exposed group compared with non-exposed group(P<0.05). ■ Conclusions It seemed to be suppression effect of organic solvents on the reproductive hormones(progesterone and estrogen) in female workers. But there was no evidence that menstrual disorder was likely to result from exposure to organic solvents, because other behavioral, psychological and work related factors may also affect menstrual function.

도금사업장의 작업환경의 유해인자 노출수준에 관한 연구

문덕환,도수영,이채관,황용식,선병관,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective : For the purpose of preparing the fundamental data and assessing the status of exposure level of chemical substances and physical agents. Methods and Material : Such as noise, two types of dust, four types of metals, seventeen types of organic solvents, and four types of other materials classified by specific chemical substances in 21 metal product plating factories classified by 28 processes. The author determined exposure level on those hazardous materials from Jan. to Dec. 2001. Results : The results were as follows: 1. The exposure level for noise was exceeded to Threshold Limit Value(TLV) in the process of 6 cases of Machining, 5 and 4 cases of pre and post-buffing, and 6 cases of waterdrop-removing, the mean noise level of all of processes was not exceeded to compliance level. 2. The exposure level for dust was not exceeded to TLV at all. 3. The exposure level for Chromium(Cr) was exceeded to TLV in Chromium plating process, metal exposure level including Zinc(Zn), Manganese(Mn), and Lead(Pb) was not exceeded to TLV. 4. The exposure level of toluene in case of organic solvents was exceeded to TLV in 1 case of finishing/cleaning, coating/developing process, respectively. 5. The exposure level of four types of other materials classified by specific chemical substances were not exceeded to TLV. 6. The exposure level for dust and metal including Zn, Mn, and Pb was decreased in comparison with two results of air monitoring performed. There was no difference of the exposure level for Cr, noise, and four types of other materials classified by specific chemical substances, and the exposure level for organic solvents was slightly increased. 7. The exposure level for noise in factories employing more than 21 workers was higher than that for noise in foadtories employing less than 20 workers. The more workers, the lower exposure level in metal including Zn, Mn. The exposure level for Cr was increasing in factories employing more than 51 workers, and the more workers the lower exposure level in organic solvents. Conclusion : According to above results, this study suggests positive work environment managements in processes exceeding exposure limit value as well as continuously consecutive work environment management in processes not exceeding exposure limit value and revealing no chronological difference of exposure level should be needed.

질소산화물의 급성 노출로 인한 폐 손상 1례

김정호,김대환,손병철,이창희,김정원,문덕환,이채언,김주인 대한산업의학회 2000 대한직업환경의학회지 Vol.12 No.2

Objectives : Lung injuries due to exposure to nitrogen oxides can occur in various process in industry. We experienced a case of chemical pneumonitis induced by accidental inhalation of nitrogen oxides emitted from the bath in an acid dipping operation. Case : Dyspnea, cough and blood-tinged sputum production, cyanosis, and tachypnea occurred after exposure to oxides of nitrogen. There were bilateral diffuse ground glass opacities in simple chest radiography and high resolutional computed tomography, hypoxemia in arterial blood gas analysis, mixed ventilation defect and reduced diffusion capacity in spirometry. As an oxygen and supportive therapy, after hospitalization, was given, the patient recovered completely from the lung injury on the 8th day after admission. There was no evidence of delayed onset of bronchiolitis obliterance or pulmonary edema in a follow-up for about 6 months. Conclusions : Acid dip operation require more efficient hooding and exhausting system for the prevention of lung injuries caused by inhalation of nitrogen oxides. Also health education for worker need.

부산지역 소방공무원의 폐기능과 호흡기증상

김성훈,김정원,,김종은,손병철,김정호,이창희,장상환,이채관 大韓産業醫學會 2006 대한직업환경의학회지 Vol.18 No.2

목적: 본 연구에서는 소방관 집단의 호흡기 증상과 폐기능을 조사하여 호흡기 질환의 유병 정도를 비교 분석함으로써 소방관의 호흡기 질환과 화재 노출과의 관련성을 규명하고자 하였다. 방법: 2004년 11월 13일부터 동년 12월 15일까지 부산 소재 4개 소방서와 부속 파출소의 남성 소방공무원 699명을 대상으로 폐기능 검사와 호흡기 설문조사를 실시하였다. 호흡기 증상 설문은 BMRC에서 개발한 설문조사표를 이용하였다. FVC, FEV_(1), MMEF 예측치는 Morris의 폐기능 예측식을 사용하여 계산하였고, 폐기능 검사 이상을 판정하기 위하여 미국 NHNES 기준에 따라 정하였다. 폐기능 측정치와 호흡기 증상은 노출유무와 흡연여부로 집단을 나누어 각각 비교분석하였다. 유의수준은 p<0.05로 정하였다. 결과: 폐기능 비교에서 화재노출군이 FVC, FVC%, FEV_(1), FEV_(1)%, FEF_(25%)는 비노출군에 비해 통계학적으로 유의하게 저하되어 있었고, 이를 흡연여부에 따라 층화하였을 때, FVC 와 FEV_(1)은 흡연여부와 관계없이 노출 여부에 따른 차이를 보이나 FVC%, FEV_(1)%, PEFR은 흡연군에서만 차이를 보였다. 폐기능 검사 이상을 비교하면 전체적으로 화재노출군이 비노출군보다 폐기능 이상자의 수가 많았고 흡연군에서 FEV_(1) 이상자의 차이는 통계적으로 유의하였다. FVC, FEV_(1), MMEF를 종속변수로 하여 다중회귀분석을 시행하였을 때, FVC와 FEV_(1)은 부분적으로 화재노출유무와 관련성이 있었다. 호흡기 증상 조사에서 화재노출군은 비노출군에 비해 코막힘, 목아픔, 흉부압박감의 증상의 호소율이 통계학적으로 유의하게 높았으나, 이를 흡연여부에 따라 층화하면 이들 증상들은 경계역의 차이를 보였다. 결론: 이러한 결과들을 종합하면 소방관은 화재진압과정에서 노출되는 많은 호흡기 유독물질로 인해 급성 폐기능 저하와 높은 호흡기 증상 호소율을 보이며, 이는 화재노출 외에 흡연의 부가적 효과가 영향을 미친다고 생각된다. 따라서 폐기능이 저하된 경방군에서 주기적인 폐기능 검사가 실시되어야 하며, 금연과 호흡기 보호구의 철저한 착용이 권장되어야 하겠다. Objective: The purpose of this study was to evaluate the relationship between respiratory disorders and fire exposure by investigating and analyzing the lung function and respiratory symptoms of firefighters. Methods: The health effects of firefighting on respiratory function were investigated in 699 male fire officers in 4 fire departments in Busan by recording respiratory symptoms and measuring lung function. The data were analysed according to fire exposure and smoking habits. Results: Mean spirometric data showed significantly decreased levels in the fire-exposed group (FVC, -0.20 L; FVC%, -4.2%; FEV_(1) -0.21 L; FEV_(1)%, -5.1%; FEF25%, -0.13 L/SEE p<0.05). After stratification by smoking habits, FVC and FEV1 showed a significant difference between groups. The prevalence of spirometric abnormality was greater for the fire-exposed group than for the non-exposed group. Significantly higher prevalences of nasal stiffness (16.7% vs. 10.9%), sore throat (17.7% vs. 14.2%) and chest tightness (6.5% vs. 2.5%) were recorded in fire fighters compared to controls (p<0.05). However, after stratification by smoking habits, the 3 symptoms were showed only marginal differences in the smoking group. Conclusions: This study demonstrated that fire-exposed firefighters generally suffer a decline of lung function and a higher prevalence of respiratory symptoms. These results suggest that the exposure to routine firefighting activity is associated with adverse health effects to the respiratory system.

소규모사업장 용접근로자들의 소음·용접흄·망간 노출에 관한 연구

김동구,문덕환,이채관,박명희,함성애,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective : This study was conducted for the purpose of investigating the level exposure of welders to noise, welding fume and Manganese(Mn) related to this process. Methods and Material : All subjects in this study were welders engaged in CO2 arc and coated arc welding process especially in small-scale enterprises classified by type of manufacture of ship building, repairing and of other fabricated metal products, which is located in Gimhae and Milyang of Kyeongsang province in south Korea. Air sampling of welding fume was measured, shipped and analyzed on the basis of national institute for occupational safety and health(NIOSH) method in U.S. and work environment measurement method established in south Korea. To measure Noise in the work environment, Noise dosimeter was used on the basis of work environment measurement method established in south Korea. Result : This study was performed during a period from January, 2000 to December, 2001 and Results were as follows: 1. Noise level measured in this work environment was higher than national criteria for permissible exposure limit on health examinations related to hearing loss. 2. The concentration of welding fume and Mn in manufacture of ship building and repairing was higher than those in manufacture of other fabricated metal products. 3. In conditions of existing in ventilation system installed and operated, the concentration of welding fume and Mn was slightly lower than those of not existing. 4. In conditions of existing in sufficient air supply from out door into the work place relied on natural exhaust system, the concentration of welding fume and Mn was slightly lower than those of in not sufficient. 5. In all subjects, a rate of wearing ear plug and respiratory mask for dust and fume was lower than that of not wearing. Conclusion : According to above results, this study suggests that more positive work environment managements such as the use of portable local ventilation system, the supply of highly qualified personal protective equipment, and consecutive education and training related to health protection should be need to acquire suitable health protection program for welders engaged in small-scale enterprises in Korea.

부산지역 모 공단 및 인근지역 사업체의 산업보건 실태에 관한 조사연구

이동영,손혜숙,이채언,박형종,김대환,엄상화,최성용,유병철 인제대학교 1993 仁濟醫學 Vol.14 No.4

부산지역 공단 및 인근지역 사업체의 산업보건실태를 파악하기 위하여 205개 사업체의 보건담당자를 대상으로 1990년도의 보건실태에 관한 설문조사를 하였다. 조사내용을 일반사항, 보건관리실태에 관한 사항, 작업장 유해환경 및 보호구 지급사항, 건강관련 사항 및 근무조건에 관한 사항 등으로 대별하여 분석ㆍ관찰하였다. In order to obtain the fundamental data for developing more effective and acceptable programs of public health manegement in an industrial complex, 205 health manager in the plants answered the questionaire of the status of industrial health during 1990. The questionaire consisted of general charateristics, health care status, environmental problems, health problems, and others. 72.4% of 205 plants had less than 100 workers. Fabricated metal manufacture was 32.4%. Although Footwear manufacture was 6.4%, the percentage of workers was 33.1% of total workers. The percentage(56.2) of retired women was higher than that(38.2) of men. 51.9% of total plants has recieving group health care services. 85.4% of plants was exposed to noise, 66.5% was exposed to dust. Ear plug and mask were given to prevent noise and dust in 69.2% and 68.6%, respectively. Among 22,299 workers, 618(2.8%) were diagnosed as suspected non-occupatinal disease. 85.9% of them worked on continuously and had their disease treated. The cases suspected for occupational disease was 100 workers. 82.5% of them changed their post. 45% had the compensation for their occuaptional disease. The rate of working: accidents was 2.3%.

자동차차체 및 부품제조업 산업장의 작업환경실태에 관한 조사 연구

서준호,문덕환,김정호,이채관,황용식,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objectives: For the purpose of preparing the fundamental data and control the working environment and assessing the status of working environmental in manufacturing industry of bodies for motor car and of parts. Methods and Materials: Accessories for motor car and its engines the auther measured the noise level, concentration of dust, heavymetals, organic solvents, chemicals to 99 industries(24 working processes) form Feb. 2000 to Oec. 2000. Results: The results were as follows : 1. Mean noise level cutting, grinding, pressing, foundries and shot-blast was exceeded to threshold limit value(TLV) of noise. 2. Mean concentration of total dust was not exceeded to TLV. 3. Mean concentration of Mn in welding process and Pb in drying, welding, fabricating, rolling was exceeded to TLV. 4. Mean concentration for chemicals and organic solvents were not exceeded to TLV. 5. Mean concentration of dust and heavymetals were statistical significant difference between with local ventilation system and without local ventilation system. Conclusion: Above results, author suggest to prepare more passively control to working environment where exceeded the TLV.

도장작업시 유해인자들의 노출수준과 작업환경관리실태

이세기,문덕환,이채관,황용식,선병관,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objectives: For the purpose of preparing the fundamental data and assessing the status of exposure level of chemical substances in painting process. Methods and Materials: The author determined the concentration of organic solvents, lead(Pb), Chromium(Cr), and Toluene-2, 4-diisocyanate(TDI) in air of painting process to 90 industries classified by 15 types of manufacturing industry during a period from Jan. 1st 2001 to Dec. 31st 2001. Results: The results were as follows: 1. The geometric mean level of each chemical substance was 0.1706 ppm for exposure index in organic solvents, 0.0019㎎/㎥ for Pb, 0.0024 ㎎/㎥ for Cr, and 0.0004ppm for TDI, respectively. 2. The exposure level of each chemical substances by type of painting was the highest in dipping and brush painting for organic solvent, in spray-painting for TDI, and in spray gun-painting for Pb and Cr, respectively. 3. The exposure level of each chemical substances by type of local ventilation equipment was higher in enclosed and booth type for organic solvents. Cr, and TDI, and in exterior type for Pb, respectively than those of other types. 4. The exposure level of each chemical substances by type of hazardous material arresting media was higher in using water for organic substances, in using bag filter for Pb, TDI, respectively than those of other types. Conclusion: According to above results, this study suggests that the exposure level by type of industry exceeded the exposure level in wooden furniture and metal furniture manufacturing industry for organic solvents and Pb, respectively.