갑상선 결절의 임상양상과 미세침흡인검사의 의의

원진호,한희정,채수홍,김현진,송민호,김영건 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

We evaluated clinical manifestation of nodular thyroid disease and fine-needle aspiration cytology results to establish an appropriate diagnostic approach to thyroid nodule. We examined 594 patients who visited Chungnam National University Hospital with one or more thyroid nodules between Jan. 1996 and Dec. 1998. Fine-needle aspiration cytology was carried out after clinical evaluation including medical history, physical examination(hardness,size, multinodularity,fixation) and laboratory test(scan, thyroid function test). Among the 594 cases, 53 cases(8.9%) were diagnosed as cancer and 457 cases(77%) were diagnosed as benign nodule. None of these factors - age, sex. soft and firm nodule, multinodularity, thyroid scan, thyroid sonography, and thyroid function test - were significant to predict cancer in our study. The prevalence of cancer was significantly higher in hard nodule(28. 5%,39/137) than firm(3.8%,12/316) or soft nodule(0%,0/72). There was size difference between malignant(24.2±62.8ml) and benign nodules(12.6±26.1ml),but the size difference wasn't shown to an indicator to say whether malignant or benign. The prevalence of cancer in relation to fixation was significantly higher in fixation(50%,19/38) and partial fixation nodule(33%,4/12) than movable nodules(5.8%,28/476). Rapid growing, vocal cord palsy,and lymphadenopathy among the medical history had higher relative risk to cancer (relative risk= 14, 4.8, 10.2. respectively). We also examined 67 cases which were diagnosed by histology after operation and, through comparison between the results of histology and cytology., evaluated the effectiveness of fine-needle aspiration cytology. Sensitivity, specificity, false negative rate, and false positive rate of fine-needle aspiration cytology were 92-100%, 47-63%, 0-20%, 0-50%,respectively. Our data suggests that thyroid nodules of the patients which are characterized firm, fixed, rapid growing, lymphadenopathy, and vocal cord palsy require more careful evaluation for thyroid cancer. We also recommand thyroid aspiration cytology in first step evaluation to rule out thyroid cancer.

폐경후 여성에서 치료 약제에 따른 부위별 골밀도의 변화

안봉수,신재규,주원찬,송민호,노흥규 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

Because of the prolongation of life span, the postmenopausal osteoporosis is a serious health problem, which needs active preventive and conservative measures. Recent evidence suggests that estrogen replacement therapy .(ERT), calcitonin, bisphosphonate and ipriflavone treatments are effective in preventing bone loss in postmenopausal women. In this study, we evaluated the effects of estrogen, ipriflavone, and combined therapy with estrogen and ipriflavone to BMD in various bone sites (lumbar spine, femoral neck and Ward's triangle). Forty-eight patients were devided into 3 groups by treatment modalities which are estrogen and ipriflavone group (n=12). After basal bone mineral desity (BMD) were determined by DEXA. (Dual energy X-ray absorptiometry. Lunar Radiation Corp. U. S. A. ), the patient were received medication according to each treatment protocol. The patients with estrogen treatment group were 2mg estradiol and 10mg of medroxy progesterone for 21 days a month. The patients of ipriflavone treatment group were received 600mg daily. The patients with combined therapy with estrogen and ipriflavone were received same dose of other two treatment groups. The BMD after treatment were compaired with basal BMD. The results were as follows. 1) The BMD in lumbar spine and femoral neck were significantly increased after estrogen treatment. 2) The BMD in lumar spine was significantly increased after ipriflavone treatment but the BMD in femoral neck and Ward's triangle were not increased with ipriflavone treatment. 3) After combined therapy with estrogen and ipriflavone, the BMD in each sites were increased and the BMD in Ward's triangle was more incresed than estrogen or ipriflavone treatment alone. In conclusion, estrogen prevented cortical bone and trabecular bone loss. ipriflavone prevented trabecular bone loss. The combination with estrogen and ipriflavone was increased effects of estrogen to prevent trabecular bone loss.

천추 갈색종양(Brown tumor)으로 발현된 부갑상선 기능항진증 1예

홍우정,구본정,이재민,한상우,이효진,나소영,노흥규,김영건,송민호 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

부갑상선 기능항진증에 의한 골병변으로 갈색종양이 있다. 갈색종양은 주로 장골을 침범하고 척추골에서의 발생은 매우 드물다. 국내의 보고에서 갈색종양의 장골 침범은 있었으나, 척추골에서의 발생은 보고된바 없다 .저자들은 부갑상선 기능항진증으로 인하여 척추골의 천추에 발생된 갈색종양 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The bony involvement in primary hyperparathyroidism present as browm tumor or osteitis fibrosa cystica and lead to pathologic fracture. Brown tumor commonly involve long bone such as femur, tibia, fibula, humerus, and radius. Brown tumor of axial skeleton is a rare entity. Previously reported case that involve axial skeleton still not present. We report a 47-year-old male patient that he has a hyperparathyroidism presenting as brown tumor involving sacrum.

당뇨병의 급성 대사성 합병증에 대한 임상적 고찰(Ⅲ)

김영건,구본정,박소영,김윤,원진호,송민호 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

We observed clinical features in 26 patients with acute metabolic complications of diabetes mellitus, diabetic ketoacidosis 21 cases and hyperosmolar nonketotic coma 5 cases who were diagnosed and treated in chungnam National University Hospital from January 1993 to December 1993. The overall incidence of diabetic inpatients with acute metabolic complications were 2.6 percent. The mean age of the diabetic patients with acute metabolic complications was 48.0 year-old. The durations of the diabetic patients with acute metabolic complications were 5.9 years and only 4(15.1 percent) out of the 26 patients with acute metabolic complications were presented as a initial manifestations of diabetes mellitus. Gastrointestinal symptoms were the most common complaints in the patients with diabetic ketoacidosis and altered consciousness was in the patients hyperosmolar nonketotic coma. Dehydration was the most common physical findings in both groups of patients with diabetic ketoacidosis and hyperosmolar nonketotic coma. Omission of the insulin therapy and infections were the most mommon precitipation factors for the development of diabetic ketoacidosis and hyperosmolar nonketotic coma, respectively. The mortality rates of the patients with diabetic ketoacidosis and hyperosmolar nonketotic coma were 7.7 percent and 20 percent, respectively.

폐경기후 골다공증의 약물요법

노흥규,송치운,이진홍,안미애,송민호 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Postmenopausal osteoporosis is an enormous public health problem. Estrogens, and various drugs were developed and used for prevention and treatment of postmenopausal bone loss. In this study, We evaluated the effects of cycloprogynova, cyclofenil and ipriflavone on postmenopausal bone loss. Fourty post menopausal women were divided into 3 groups by treatment modalities Cyclofenil group (groupl), Cycloprogynova group(group 2) and Ipriflavone group(group 3). Basal bone mineral densities in all subjects were determined by DEXA(Dual Energy X-ray Absorptiometry) and those were compared with bone mineral densities after medication. The durations of medication in all groups were showed no statistical difference, group 1 11.4 ± 3.4 months, group 2 10.6 ± 3.9 months, group 3 12.9 ± 3.4 months. The patients of group 2 showed significant increase in bone mineral densities and the patients of group 1 and group 3 revealed no significant bone loss on paired T-test. Comparing with rates of bone loss in normal Korean postmenopausal women, the rates of bone loss in all subjects were effectively retarded. The significant bone loss (above longterm intertest coeffcient of variation) was noted in 8 patients out of 23 subjects in group 1, in 9 patietns out of 11 subjects in group 2 and in 2 patients out of 6 subjects in group 3. In conclusion, estrogen/progesteron(Cycloprogynova) replacemnt therapy showed most prominent bone preserving effect and Cyclofenil and Ipriflavone also effectively delays shorterm bone loss in postmenopausal women.

부신 결핵에 의한 Addison씨병 1예

송치운,구본정,안봉수,전준식,안미애,이진홍,송민호,김영건,노흥규 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

Addison's disease is a rare primary adrenal insufficient disorder resulting from chronic deficiency of adrenal cortical hormones. Clinical manefestations are generalized weakenss, weight loss, hyperpigmentation (especially sun exposed area and mucous membrane), hypotension, hyponatremia, hyperkalemia, gastrointestinal symptoms (involving anorexia, nausea, vomiting, abdominal pain). A 34-year-old woman has experienced slowly progressive generalized weakenss and skin pigmentation, anorexia, nausea, vomiting with ascites and diffuse abdominal pain. On the time of admission, her main clinical manifestations were anorexia, nausea, vomiting, fatigue, generalized weakness, amenorrhea, hair loss, diffuse abdominal pain revealed as Addison's disease due to bilateral adrenal tuberculosis. Her adrenal insufficient symptoms were recovered with the replacement of adrenocortical hormones and antituberculous medications. After treatment, Her skin pigmentation was decreased and menstruation was reappeared. Here we experienced one cases of Addison's disease with tuberculous peritonitis.

당뇨병에 합병한 고지혈증에 대한 Acipimox(Olbetam)의 효과

김영건,김진희,전준식,송치운,송민호 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Multiple abnormalities of lipoprotein metabolism exist in patients with diabetes mellitus that could contribute to their enhanced susceptibility to atherosclerosis. Acipimox(5-methyl-pyrazine carboxylic acid 4-oxide, Farmitala Carlo Erba, Milano Italy) is a new potent and long acting(8h) antilipolytic agent, which has been derived from nicotinic acid. By lowering plasma and possibly skeletal muscle concentrations of non-esterified fatty acid, Acipimox may have a potential beneficial effect on glucose metabolism in patients with non-insulin dependent diabetes mellitus. The aim of this study was to evaluate the acute effect of Acipimox on hyperlipidemia associated with non-insulin dependent diabetes mellitus. 18 patients with non-insulin dependent diabetes mellitus were in the study. They had fasting plasma triglyceride concentrations above 250 mg/dl and cholesterol concentrations above 240 mg/dl. The level of triglyceride, cholesterol and glycated hemoglobin were significantly reduced after 8 weeks treatment of Acipimox. Adverse effects were noted in 3 patients, but it was transient with the course of administration. Acipimox is an effective and safe drug for the management of hyperlipidemia associated with non-insulin dependent diabetes mellitus.

당뇨병환자에서 게이트심장혈액풀신티그라피를 이용한 심기능 평가

윤상임,송치운,이진홍,안미애,성기양,송민호,이강욱,신영태,김영건,노흥규 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Major cardiovascular complications of diabetes are coronary atherosclerosis, diabetic dilated cardiomyopathy, autonomic neuropathy and those are major causes of morbidity and mortality in diabetic patients. Gated blood pool heart scan is noninvasive and useful method for evaluation of functional status of heart in diabetics. We evaluated 52 patients with diabetes and divided 3 groups. Group 1 were 11 patients without proteinuria or with proteinuria less than 550mng during 24 hours. Group 2 were 9 patients with proteinuria more than 550mg during 24 hours and group 3 were 32 patients with endstage renal diasese due to diabetes. We performed 99mTc-HSA cardiac gated blood pool scan and used left ventricular ejection fraction(LVEF), peak ejection rate(PEF) to indices of LV systolic function and peak filling rate(PER) to index of LV diastolic function. The results were follows : 1) LVEF, PER were significantly lower in diabetics with ESRD than diabetics without ESRD, but there were no significant difference between normal controls and diabetics without ESRD 2) PFR was significantly lower in diabetics than normal controls, but there were no significant differences in diabetics with or without nephropathy. 3) There were negative correlation between PER, PFR and duration of diabetes. On the basis of results, PFR is a LV functional index of GBPS which can disclose early change of LV dysfunction in patients with diabetes.

그레이브스병 환자에서 방사성 옥소(^131Ⅰ)치료의 효과

노흥규,안봉수,신재규,주언찬,송민호 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

Graves' disease is characterized by diffuse hyperplasia of thyroid gland, hypersecretion of thyroid hormones, ophthalmopathy, and localized pretibial myxema. Although the pathogenesis of Graves' disease is still obscure, but the TSH receptor antibodies have pathophysiological role in the hyperplasia of the gland and autonomous over production of thyroid hormones through the stimulation of TSH receptor. Radioiodine (^1311I) has been used for the treatment of Graves' disease for many years and is regarded as an treatment for the cases who is not remit following a course of antithyroid drug. To evaluate the efficacy and side effects of radioiodine treatment in Graves' disease, we studied clincal outcome after fixed dose(5-20mCi) of ^131I The results were as followings; 1) The mean dose of 9. 1mCi of ^131I administration makes 12 patients euthyroid out of 41 patients with Graves' disease. The dose of radioiodine(^131I) used for the treatment was not significantly different in hypothyroid group (3/41; 7.3%) or hyperthyroid group(26/41; 63.4%) after ^131I treatment. 2) The clinical outcomes after radioiodine (131I) treatment was not depend on the age and sex and thyrotropin receptor binding inhibitory immunoglobulins(TBII) of radioiodine(^131I) administered patients, but only the short duration of antithyroid drug treatment(the period of observation of the responce to antithyroid drug) before the radioiodine administration increase the incidence of radioiodine induced hypothyroidism. 3) The cumulative incidence of hypothyoidism after radioiodine(^131I) administration was 39.4% after third treatment. In conlusion, radioiodine treatment in fixed-dose is effective; it can induce euthyroidism or hypothyroidism in 33 out of 41 patients without major complications. With this study, we could confirm the efficacy of radioiodine treatment in a minor groups of patient who its difficult to maintain remission after antithyroid drug.

당뇨병의 급성 대사성 합병증에 대한 임상적 고찰(Ⅱ)

김영건,육은주,성자원,허승식,송민호 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

We observed clinical features in 43 patients with acute metabolic complications of diabetes mellitus, diabetic ketoacidosis 36 cases and hyperosmolar nonketotic coma 7 cases who were diagnosed and treated in Chunangnam National University Hospital from Jan. 1988 to Dec. 1992. The range of age of the patients with diabetic ketoacidosis was from 2nd decade to 9th decade. The diabetic ketocacidosis was most frequent in the 4th decade(22.2%). But the range of patients with hyperosmolar nonketotic coma was from 6th decade to 9th decade and that compications was most frequent in 6th decade. There were no significant sex difference in the groups of acute metabolic complications. The altered consciousness was the most common complaints both groups of diabetic ketoacidosis and hyperosmolar nonketotic coma. Omission of insulin therapy, infection, and fasting were the most common precipitating factors for the development of diabetic ketoacidosis and hyperosmolar nonketotic coma. Only 3(8.3%) out of 36 patients with diabetic ketoacidosis were presented as the initial manifestations of diabetes mellitus. The mortality rates of the patients with diabetic ketoacidosis and hyperosmolar nonketotic coma 5.6% and 28.6%, respectively.