당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

혈관질환 정보관리 시스템

김동익,김덕경,허세호,이병붕,김용신,김은숙,문지영,도영수,신성욱,김동수,김만태,진재욱,김용신 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1

As medical technology progresses rapidly, there is a rise in the average age along with the Korean dietary lifestyle becoming more westernized, which leads to an increase in the number of vascular disease patients in Korea. Thus, we need to manage the medical information of a disease systematically in order to diagnose and treat constructively. However, since there has been no standardized method of man agement to date, a great deal of information could not be properly utilized nor studied. Therefore, the departments of Cardiology, Radiology and Neurology of Samsung Seoul Hospital recently got together to develop an information management system called the Vascular Data System. This program was developed to be run on win98 O/S, upper Pentium Ⅲ, and upper 128 MB Memory, and its source code is Dephi 4.0. It was configured for the user to set the configurations as well as do a variety of search and analysis. If this program were to be updated continuously, it may be used extensively as well as in various parts of clinical research activities.

Magnetic resonance images of ameloblastoma

Kim, Jae-Duk,Kim, Jin-Soo 대한구강악안면방사선학회 2005 Imaging Science in Dentistry Vol.35 No.4

Purpose : To classify and describe the characteristic features of MRI of some ameloblastoma variants. Materials and Methods : The MR images, CT images, and panoramic radiographs in 5 cases were retrospectively examined as follows. First, the contents of ameloblastomas were devided into two portions of either solid or cystic components on the basis of MR signal intensities. The signal intensity within the solid or cystic portions was classified as homogeneous or heterogeneous. Next, the characteristic internal feature of the lesion on T1W1 or T2WI was described. The signal intensities were classified into low, intermediate, slightly high, high, and strong high signal intensity. Results : Unicystic lesion showed homogeneous high signal intensity (SI) on T2W2 and the rim enhancement of the surrounding area including the mural nodule and the thick wall except the central portion on Gd-T1W1 Solid type revealed heterogeneous and high SI area with strong high SI area on T2W2. On Gd-T1W1, the area corresponding to the low signal spot on T1W1 and the strong high signal spot on T2W1 showed low SI. Hybrid type showed slightly enhanced capsular structures and low SI for the round bony septa and the areas connecting the mixed and cystic lesions on T2W1 and Gd-T1W1. Conclusion : MRI could easily assess the relationship between the mixed and cystic findings in ameloblastoma.

Metastatic hepatocellular carcinoma on the mandible : A case report

Kim, Jin-Soo,Kim, Jae-Duk 대한구강악안면방사선학회 2005 Imaging Science in Dentistry Vol.35 No.4

Hepatocellular carcinoma is one of the most common cancer worldwide, primarily affecting those in regions with a high prevalence of viral hepatitis. However, the metastasis of hepatocellular carcinoma to the oral cavity is a rare phenomenon. This report presents a case of metastatic hepatocellular carcinoma in the left mandibular angle and ramus region of a 62-year-old man. Panoramic radiograph revealed an ill-defined radiolucent lesion extending from the retained root of the mandibular left second molar into the ascending ramus. The lesion had irregular and ill-defined margins.

Increased Urinary KIM-1 and Tubular KIM-1 Expression in IgA Nephroapathy (초)

( Mi Seon Seo ),( Soon Hyo Kwon ),( Moo Young Park ),( Soo Jung Choi ),( Jin Seok Jeon ),( Hyun Jin Noh ),( Jin Gook Kim ),( Dong Cheol Han ),( Seung Duk Hwang ) 대한내과학회 2010 대한내과학회 추계학술대회 Vol.2010 No.-

안지오텐신 변환효소 억제제와 안지오텐신 II 수용체 차단제 투여 후 발생한 급성 신부전과 폐부종으로 전원된 선천성 단일신 환자의 치료 1예

백두현,김경진,홍성철,강석형,송하응,김혜인,김수현,오현정,강혜원,김서우,유민아,류동열,최규복,강덕희 이화여자대학교 의과대학 2010 EMJ (Ewha medical journal) Vol.33 No.1

Blockers of renin-angiotensin system(RAS) including ACE inhibitor or ARB are one of the most frequently prescribed medications for the treatment of hypertension, heart failure and proteinuria. One of the major side effects of these RAS blockers is the deterioration of renal function, mainly due to a reduction of intraglomerular pressure. Therefore, close monitoring of renal function is recommended when RAS blockers are initially prescribed, especially for the patients with impaired renal function. We report a patient who was transferred to our hospital due to the sudden development of oliguria and dyspnea after treatment for hypertension with ACEi and ARB. She was finally diagnosed as RAS blocker-induced acute renal failure with pulmonary edema complicated on congenital solitary kidney. After hemodialysis and conservative treatment, her renal function was recovered with maintenance of normal urine output. Conclusion:This case highlights the necessity of the functional and structural evaluation of kidney to prevent the serious complication such as acute renal failure before the administration of ACEi and/or ARB.

반지세포(Signet-ring cell) 위암의 피부전이 1예

김성준,박현수,이용석,전덕규 대한피부과학회 2003 大韓皮膚科學會誌 Vol.41 No.6

Signet-ring cell(SRC) is formed by intracytoplasmic accumulation of various substances which push the nucleus to the cellular border so that the cell looks like a signet ring. Most cutaneous SRC neoplasms are metastatic adenocarcinomas. SRC, when seen in skin, may indicate that the primary origins are from the stomach, colon or breast. The SRC formations in cutaneous neoplasms other than metastatic adenocarcinoma have also been reported such as SCC, BCC, metastatic melanoma etc. We experienced a case of cutaneous metastasis of SRC gastric carcinoma which the first symptom was skin lesion of the scalp. (Korean J Dermatol 2003;41(6): 808~810)

Thiazide를 투약 중이던 고령의 환자에서 발생된 중증 저나트륨혈증 1례

김진국,최수정,황승덕 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Hyponatremia is the most common electrolyte disorder in hospitalized patients, and incidence of hyponatremia is about 1-4%. It is suggested that hyponatremia is closely related with morbidity and mortality in these patients. Diuretic-induced hyponatremia is one of the most common causes of hyponatremia associated with hypovolemic hypoosmolality, but serious hyponatremia due to diuretic use is relatively uncommon. Advanced age may be a predisposing cause, and women is more susceptible than men, but no definite proof has been documented. The severity of symptoms can be roughly correlated with velocity and degree of hyponatremia, and neurological symptoms generally do not occur until the serum sodium falls below 125 mEq/L. Rapid development of hypoosmolality can result in brain edema before brain adaptation occurs by excreting intracellular solutes. In the most severe cases death can result from respiratory arrest after cerebral herniation. So, it is need to optimal treatment for neurological symptoms. We report a case of serious thiazide-induced hyponatremia in elderly hypertensive man which were aggravated by infusion of simple dextrose solution without electrolyte for severe watery diarrhea.

메탈라스와 와이어메쉬로 횡구속된 철근 콘크리트 기둥의 내력 및 연성에 관한 연구

김병철,이우진,정덕우,윤승조,김성수,한천구 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.1(구조계)

Generally, transverse steel in reinforced concrete column serves the three-fold function of confining the compressed concrete, preventing lateral buckling of the longitudinal reinforcing steel, and acting as shear reinforcement. However, the amount of confining steel required in the form of rectangular hoops is still argument. This paper summarizes the results of an experimental program where 10 short columns with compressive strength 21MPa are designed with variable lateral confinements such as Metal Lath and Wire Mesh were tested under monotonic axial compression to failure. The columns were 300mm square and 750mm high. The purpose of this study is to investigate the ductility and strength of columns with variable lateral confinement. Test results indicate that specimen confined by metal lath and hoop, and wire mesh and hoop show 1.89 times ductility than NO.I specimen using hoop only. However, effect of lateral confinement by metal lath and wire mesh is how or same than NO.I specimen in maximum strength.

靑綠色 燐酸바륨顔科의 製造와 物性

金燦國,薛秀德 동아대학교 공과대학 부설 한국자원개발연구소 1979 硏究報告 Vol.4 No.1

Ba(CH)₂·8H₂O, (NH₄)₂HPO₄ 및 MnO₂간의 混合比를 任意로 變化시킨 試料를 電氣爐에 넣고 하燒溫度를 變化시켜 Ba₃(PO₄)₂를 製造하는 實驗이다. 混合比 3:1:2:1.2의 試料를 800℃에서 3時間 가량 하燒시켜 본 結果, 90% 以上의 收得率을 가진 靑綠色의 α-Ba₃(PO₄)₂가 生成되었다. A study on the formation of Ba₃(PO₄)₂ was carried in different sample that change mole ratio of Ba(OH)₂·8H₂O, (N₄)₂HPO₄, MnO₂ and changed their calcined temperature in an electric muffle furnace. When sample thus mixed mole ratio 3.1.2.1.2 was calcined at a temperature range 800℃ for 3 hours, 90% and over calcined material was recovered in the form of α-Ba₃(PO₄)₂ with a greenish blue colour.