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증례 : 만성중이염에서 기원한 폐렴막대균(Klebsiella pneumoniae)에 의한 괴사성 근막염 1예
김병국 ( Byung Kook Kim ),이정현 ( Jung Hyun Lee ),이승준 ( Seoung Joon Lee ),기현균 ( Hyun Kyun Ki ),송기호 ( Kee Ho Song ),김동림 ( Dong Lim Kim ),김숙경 ( Suk Kyeong Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.6
저자들은 당뇨병과 알코올성 간경변이 있는 45세 남자 환자에서 원발병소가 K. pneumoniae 만성중이염이고 속발된 세균혈증으로 인한 K. pneumoniae 괴사성 근막염 1예를 경험하였기에 보고하는 바이다. Necrotizing fasciitis is a relatively uncommon infectious disorder where a bacterial organism penetrates the subcutaneous tissues and superficial fascia, ultimately causing necrosis of vast areas of soft tissue. Although invasive Streptococcus spp., most commonly group-A streptococci, is the most frequent cause of this disorder, in a single organism-infection, necrotizing fasciits caused by Klebseilla pneumoniae is becoming more frequently reported, perhaps due to the recent increase in the frequency of diabetes and liver diseases. Necrotizing fasciitis caused by K. pneumoniae is usually secondary to hematogenous dissemination, most commonly caused by trauma or liver abscess and usually results in multiple organ failure. The progression of the disease is so rapid that the mortality rate is high despite aggressive surgical intervention and extensive use of antibiotics at an early disease stage. Here we report a case of necrotizing fasciitis caused by hematogenously spread K. pneumoniae from incompletely treated chronic otitis media in a patient with alcoholic liver cirrhosis and diabetes. (Korean J Med 72:689-695, 2007)
Lovastatin이 골격근 세포의 지방산 산화에 미치는 영향
김동림 ( Dong Lim Kim ),송기호 ( Kee Ho Song ),김숙경 ( Suk Kyeong Kim ),김해림 ( Hae Rim Kim ),( Theodore P. Ciaraldi ),( Robert R. Henry ) 대한내과학회 2007 대한내과학회지 Vol.72 No.6
목적: Statin이 혈당을 감소시키고 인슐린 저항성을 개선시킨다고 보고되었다. 본 연구는 statin이 인슐린 저항성의 주 조직인 골격근에서 지방산의 산화에 어떤 영향을 미치는지를 알아보고자 하였다. 방법: 정상 혈당군 7명과 제2형 당뇨병 환자 7명에서 근육 생검으로 골격근 조직을 얻었다. 골격근 세포를 배양하여 분화 후 lovastatin (0, 20 μM)을 배지에 첨가하고 2일 후 [9,10-3H] palmitate 와 [8-3H] octanoate를 이용하여 지방산 산화를 측정하였다. 유리 지방산 산화를 조절하는 기전을 알아보고자 AMPK와 ACC 인산화를 관찰하였다. 결과: Lovastatin 처리 후 대조군과 비교하여 palmitate의 산화 및 (44.2±12.1 nmol/mg protein/3h, 271.2±32.7% 증가 vs 15.5±3.0 nmol/mg protein/3h, p<0.01) octanoate의 산화가 유의하게 증가하였다(10.0±4.6 nmol/mg protein/3h, 158.3±21.9% 증가 vs 5.0±1.4 nmol/mg protein/3h, p<0.05). 이런 반응은 정상 혈당군과 제2형 당뇨병 환자의 골격근 세포 모두에서 유사하였다. Lovastatin 처리 후 AMPK의 인산화는 관찰되지 않았지만 AMPK 단백은 감소하였다(73.6±6.2% of control, p<0.01). ACC의 인산화는 통계적으로 유의하게 증가하였다(149.5±20.6% of control, p<0.05). 결론: ACC 인산화를 통한 지방산 산화의 증가가 lovastatin이 골격근에 침착된 지방 농도를 감소 시키고 인슐린 저항성을 호전시킬 것으로 생각된다. Background: Recent clinical studies have suggested that statins improve insulin resistance and glucose metabolism in the skeletal muscle of diabetic patients. To evaluate a possible component of this action, we measured free fatty acid oxidation in cultured human skeletal muscle cells (HSMC). Methods: Seven normal controls and 7 type 2 diabetic patients underwent quadriceps muscle biopsy. The HSMCs (n=14) were treated with or without lovastatin (Lova, 20 μM) for 2 days, and the free fatty acid (FFA) oxidation was measured. Results: Lova increased the oxidation of the long-chain FA palmitate to 271.2±32.7% of the control (p<0.01). Oxidation of the medium chain FA octanoate also increased after treatment of Lova (158.3±21.9%, p<0.05). One pathway of regulation of FFA is through AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC) phosphorylation. Following Lova treatment, AMPK phosphorylation did not show a significant change while the total protein expression of AMPK was decreased (73.6±6.2% of the control, p<0.01). Lova treatment significantly increased ACC phosphorylation (149.5±20.6% of the control, p<0.05). Conclusion: Lova increased FFA oxidation by increasing the ACC phosphorylation in human skeletal muscle cells. Stimulation of skeletal muscle FFA oxidation may be one mechanism by which statins act to lower intramyocellular triglyceride and improve insulin action on glucose metabolism. (Korean J Med 72:600-606, 2007)
증례 : 제2형 당뇨병환자에서 국소형 Nesidioblastosis에 의한 저혈당 1예
이은정 ( Eun Jung Lee ),송기호 ( Kee Ho Song ),김숙경 ( Suk Kyeong Kim ),장성환 ( Seong Hwan Chang ),김동림 ( Dong Lim Kim ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.3
Nesidioblastosis는 췌장 상피 세포로부터 발생하는 소도세포의 증식을 특징으로 하는 질환으로 성인에서 국소형 nesidioblastosis에 의한 저혈당의 보고는 거의 없었다. 본 예는 제2형 당뇨병이 있는 46세 남자 환자에서 저혈당을 주소로 내원하여 췌장 절제술을 통해 국소형 nesidioblastosis로 진단된 예이다. 수술 후 저혈당은 호전되었고 18개월 동안 저혈당의 재발없이 지내고 있다. 저자들은 성인에서 focal nesidioblastosis에 의한 저혈당 환자에서 부분 췌장절제술 후 치료된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. We report a 45-year-old man with type 2 diabetes who presented with recurrent hypoglycemia. Biochemical and imagingstudies did not show any mass-like lesion in the pancreas, so prednisolone and diazoxide were administered for the treatment of hypoglycemia. However, the hypoglycemia persisted during and after the medical treatment. A selective arterial calcium stimulation test was performed and revealed a suspicious lesion at the head of the pancreas. The patient underwent enucleation of the pancreas head lesion. The lesion was confirmed histologically to be focal nesidioblastosis and surgical resection was successfully performed. The patient showed no hypoglycemic symptoms postoperatively. (Korean Diabetes J 33:251-256, 2009)
미세단백뇨를 동반한 인슐린비의존형 당뇨병 환자를 대상으로 한 영양 상담의 효과 연구
손정민,김숙경,박형규,신찬수,김성연,이홍규 대한영양사협회 2001 대한영양사협회 학술지 Vol.7 No.2
Microalbuminuria is a strong predictor of diabetic nephropathy and is also associated with increased mortality in people with non-insulin-dependent diabetes mellitus(NIDDM) patients. Improved glycemic control and dietary protein restriction are recommended to retard and avoid developing microalbuminuria. The purpose of this study was to measure the dietary counseling effects for diabetes mellitus patients with microalbuminuria. To investigate the effects of the dietary counseling effect, thirty NIDDM patients with microalbuminuria were selected from outpatient diabetic clinic of Seoul National University Hospital for this study. None of them had evidence of renal and heart complications. For 24 weeks, they received individualized dietary counseling 3 times. The results of this study can be summarized as follows 1) Dietary protein and calorie intake decreased significantly from 79.8±29.9g/d to 66.6±16.5g/d, from 1845.4±631.9kml to 1515.7±392.7lkml after dietary counseling, respectively(p<0.05). 2) The glycosylate hemoglobin level showed significantly decreased after dietary counseling (p<0.05). However there were no change in lipid profiles and blood pressure after counseling. 3) There was a significant correlation between the duration of disease and the amount of microalbuminuria. Any other cardiovascular risk factors, such as duration of diabetes, total cholesterol level and systolic blood pressure were not correlated with microalbuminuria. These results shown that dietary counseling can be used as an effective therapy to control blood sugar levels for NIDDM patients who are poorly controlled with microalbuminuria.
사립체 유전자 tRNA^(Leu(UUR))의 점돌연변이가 확인된 인슐린의존성당뇨병 1 예
박혜원,김희주,이홍규,신찬수,김원배,정해일,김숙경,김웅흠 대한내과학회 1997 대한내과학회지 Vol.53 No.1
We describe a case of insulin-dependent diabetes mellitus(lDDM) with a mutation at nucleotide 3243 of mitochondrial DNA. A 24-years-old female presented with recurrent episodes of generalised tonic clonic seizures, cognitive decline, short stature, bilateral sensory neural hearing loss, bilateral optic neuropathy, lactic acidosis, and basal ganglia calcifications in addition to IDDM. Maternal transmission of the disease was suggested, by the fact that her mother have died of diabetic complications of the age of 50. Heteroplasmy of wild type and mutant mitochondrial DNA derived from peripheral leucocytes was detected by Apa I digestion of the polymerase chain reaction products amplified with a set of primer for tBNA^(LUR(UUR)) Adenosin-to guanidine substitution, occurring at nucleotide position 3243 in tRNA^(LUR(UUR)) gene in comparison with reference sequences was confirmed.