증례 : 급성 A형 간염 후 발생한 전격성 제1형 당뇨병 1예

권지연 ( Ji Yeon Kwon ),노미오 ( Mi Oh Roh ),송민수 ( Min Soo Song ),정찬희 ( Chan Hee Jung ),박형규 ( Hyeong Kyu Park ),김여주 ( Yeo Ju Kim ),목지오 ( Ji Oh Mok ),김상진 ( Sang Jin Kim ),김철희 ( Chul Hee Kim ),변동원 ( Dong Won 대한당뇨병학회 2009 임상당뇨병 Vol.10 No.2

전격성 제1형 당뇨병은 췌도에서 급격히 베타세포와 알파세포가 파괴되는 특징을 가진 당뇨병으로 그 기전은 명확하지 않으나 유전적 감수성이 있는 개체에서 바이러스 감염 등의 환경적인 인자와의 연관성이 가능한 병태생리로 제시되고 있으며 이에 대한 추가적인 연구가 필요하다. 저자들은 최근 급증하는 A형 간염 후에 발생한 전격성 제1형 당뇨병 1예를 경험하여 전격성 제1형 당뇨병과 바이러스 감염의 관련성에 대한 근거를 제시하고 이에 대해 보고하는 바이다. Fulminant type 1 diabetes mellitus is a novel subtype of type 1 diabetes, which is characterized by a remarkably abrupt onset, metabolic derangement such as diabetic ketoacidosis at diagnosis, low HbA1c level at onset and negative islet-related autoantibodies. The pathogenesis of this disease remains to be clarified, but the involvement of both genetic background and viruses have been suggested. We recently encountered a case of fulminant type 1 diabetes mellitus in 32-year-old male patient who was diagnosed with acute hepatitis A a month ago. Laboratory findings revealed high blood glucose level as well as evidence of diabetic ketoacidosis, but the HbA1c level was normal. The low level of plasma C-peptide indicated the loss of endogenous insulin secretion. This patient`s laboratory results met the criteria for the diagnosis of fulminant type 1 diabetes. We consider that this report can add to the body of evidence of a viral etiology of fulminant type 1 diabetes. Further study is needed to elucidate the exact pathogenesis. (Korean Clinical Diabetes J 10:118-122, 2009)

측경부 종물로 발현된 잠복 갑상선유두암종의 임상양상

이정열 ( Jung Yeol Lee ),박재홍 ( Jae Hong Park ),목지오 ( Ji Oh Mok ),고은석 ( Eun Seok Koh ),홍현숙 ( Hyun Suk Hong ),박정미 ( Jung Mi Park ),고윤우 ( Yoon Woo Koh ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2

Background and Objectives: Neck metastasis associated with occult papillary thyroid carcinomas rarely present as a lateral neck mass. This study investigates the incidence, presentation, evaluation, pathologic features, and process for definite treatment of occult papillary thyroid carcinoma presenting with a lateral neck mass. Materials and Methods: Fifty-nine patients with papillary thyroid carcinoma combined with neck metastasis were enrolled in this study. All patients underwent total thyroidectomy with lateral compartment neck dissection. The occult group consisted of 11 patients. The non-occult group comprised 48 patients. Results: Mean age in occult group was younger than non-occult group and male was dominant in occult group. We could find the abnormality of thyroid gland only in 3 of 11 (27.3%) by CT and 3 of 3 (100%) by ultrasonograpy. Fine needle aspiration biopsy (FNAB) was found to be helpful in 6 of 10 (60%). All of four false negative results consisted of cystic lesions. Mean primary tumor size was significantly smaller in occult than in non-occult group. No significant difference was observed in the other variables. Conclusion: Sole presentation as a lateral neck mass, especially in young & male should be considered in the differential diagnosis of occult papillary thyroid carcinoma. FNAB may be a initial diagnostic tool of choice. However, in case of cystic lesion, there are possibility of misleading interpretation of cytology. Although ultrasonography can be a good modality to evaluate occult papillary thyroid carcinoma, various radiologic study could not find primary thyroid focus.

증례 : 내분비 -대사 ; 시한 증후군 환자에서 발생한 스트레스성 심근병증

이승호 ( Seoung Ho Lee ),김규진 ( Kyu Jin Kim ),김보연 ( Bo Yeon Kim ),정찬희 ( Chan Hee Jung ),목지오 ( Ji Oh Mok ),강성구 ( Sung Koo Kang ),김철희 ( Chul Hee Kim ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3

Cardiogenic shock after stress-induced cardiomyopathy is very rare and serious, and a reversible, clinical consequence of untreated adrenal insufficiency that is attributable to Sheehan`s syndrome. A 53-year-old female presented with confusion, congestive heart failure, and hypotension. Endocrine testing, prior medical history, and brain MRI confirmed the presence of hypopituitarism and secondary adrenal insufficiency owing to undiagnosed Sheehan`s syndrome. After glucocorticoid replacement therapy, her cardiac function recovered completely. Stress-induced cardiomyopathy should be considered as a possible cause of unexplained heart failure in patients with Sheehan`s syndrome and adrenal insufficiency. (Korean J Med 2014;87:347-351)

원저 : 제2형 당뇨병 환자에서 Voglibose와 Glimepiride의 체중에 대한 효과

정선혜 ( Sun Hye Jung ),김대중 ( Dae Jung Kim ),이관우 ( Kwan Woo Lee ),김범택 ( Bom Taeck Kim ),김성수 ( Sung Soo Kim ),김은숙 ( Eun Sook Kim ),목지오 ( Ji Oh Mok ),안철우 ( Chul Woo Ahn ),윤현대 ( Hyun Dae Yoon ),이상엽 ( Sang Y 대한비만학회 2005 The Korean journal of obesity Vol.14 No.2

연구배경: 당뇨병 환자에서 설폰요소제나 인슐린은 체중 증가를 가져올 수 있는 반면, 메트포민은 체중 감소 효과가 있으며, 알파 글루코시다제 억제제는 체중 증가를 억제하는 효과가 있다고 보고된 바 있다. 본 연구는 초기 제2형 당뇨병 환자를 대상으로 혈당조절의 방법으로 voglibose, glimepiride, 식이요법을 사용하였을 때 각각의 체중 및 혈당조절에 미치는 영향을 비교해 보았다. 방법: 연구 대상은 제2형 당뇨병 환자로 나이는 30~75세이며, 공복혈당은 200 ㎎/dL 미만, 체질량 지수는 23.0 ㎏/㎡ 이상, 최근 2주 이내 혈당 강하제나 인슐린, 체중에 영향을 줄 수 있는 약제를 사용하지 않은 경우로 하였다. Voglibose (Basen(R)), glimepiride(Amaryl(R)), 식이요법 세 군으로 무작위 배정하였고, 신체계측 및 혈당, 당화혈색소, 혈압, 지질 등을 시작 시점과 12주 후에 측정하였다. 결과: 총 448명의 제2형 당뇨병 환자가 연구에 포함되었고, 이 중에 voglibose 군은 223명, glimepiride 군은 176명, 식이요법 군은 49명이었다. 12주 후의 체중은 voglibose 군과 식이요법 군에서 glimepiride 군보다 체중이 유의하게 더 감소하였으며 (voglibose vs glimepiride, P=0.001; diet vs glimepiride, P=0.016), voglibose 군과 식이요법 군 간에는 차이가 없었다. 반면, 당화혈색소는 glimepiride 군에서 voglibose 군이나 식이요법 군보다 유의하게 감소하였으며 (glimepiride vs voglibose, P=0.001; glimepiride vs diet, P=0.004), voglibose 군과 식이요법 군 간에는 차이가 없었다. 결론: Voglibose는 glimepiride에 비해 혈당조절 능력은 다소 떨어지지만, 상대적으로 체중감소의 효과가 있다. Background: Obesity is a major risk factor for type 2 diabetes. Improvement in glycemic control using insulin, sulfonylurea and meglitinide is often accompanied by weight gain. But metformin and α-glucosidase inhibitor have a positive effect(decrease) on weight. In this study, we compared the effect of voglibose, glimepiride, and diet alone on body weight and glycemic control after a period of 12 weeks. Methods: The patients with type 2 diabetes were randomly assigned to one of the following three treatment groups: Patients treated for 12 weeks with voglibose, those treated with glimepiride and those with diet alone. Anthropometric parameters and metabolic parameters were measured at the initial stage and after 12 weeks. The study consisted of 448 patients with type 2 diabetes. There were 223 patients in the voglibose group, 176 in the glimepiride group, and 49 in the diet alone group. Results: The patients treated with voglibose and diet alone showed higher decreased body weight compared with glimepiride group (voglibose vs glimepiride, P=0.001; diet vs glimepiride, P=0.016). In contrast, glimepiride group showed more decreased HbA1C compared with voglibose and diet alone groups (glimepiride vs voglibose, P=0.001; glimepiride vs diet, P=0.004). Conclusion: Voglibose showed more effective on body weight reduction despite the relatively weak glycemic control compared with glimepiride.

응급수술후 발생한 당뇨병성 케톤산증 및 고중성지방혈증으로 인한 급성췌장염 1예

목지오 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Severe hypertriglyceridemia in diabetic ketoacidosis are rarely observed in acute pancreatitis which usually occurred when serum triglyceride levels are above 1,000㎎/dl. Auther report a case of diabetic ketoacidosis and hypertriglyceridemia-induced acute pancreatitis after emergency operation. A 14 year old female was presented with right lower abdominal pain. She was diagnosed acute appendicitis and received appendectomy. After emergency operation, she showed polydipsia, dry mouth and drowsiness. Blood gas analysis showed severe acidosis and serum ketone body was positive. The laboratory finding showed serum glucose 412㎎/dl, HbA1C 16.9%, total cholesterol 586㎎/dl, triglyceride 1,333㎎/dl, amylase 1,942U/L, lipase 2,251IU/L. She was diagnosed as having diabeteic ketoacidosis and hypertriglyceridemia-induced acute pancreatitis. Findings of her abdominal CT was acute pancreatitis with formation of pseudocyst. She treated with continuous intravenous insulin infusion and fluid replacement without feeding. After conservative management of 15 days, general condition gradually improved and her serum glucose, amylase, lipase and triglyceride levels ware normalized. After 13weeks, findings of abdominal CT showed improved pancreatitis and pseudocyst.

부갑상선 선종에 의해 발생된 극심한 고칼슘혈증을 동반한 갈색종 1예

목지오 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.2

Most of primary hyperparathyroidism results from parathyroid adenoma, and is characterized by hypercalcemia, reduced bone density, frequent renal stone, gastric ulcer, duodenal ulcer, muscle weakness, depression, hypertension, anemia, and rarely brown tumor. We had a case of an 80-year-old man having brown tumor caused by primary hyperpara- thyroidism on the right 10th rib confirmed by CT guided bone biopsy. The patient presented with decreased level of consciousness, acute gastric ulcer, acute duodenal ulcer, GB stones, renal insufficiency, depression, and osteoporosis. Serum calcium level was 16.7 mg/dL and the intact parathyroid hormone level was 3901 pg/mL. A parathyroid mass was detected by neck CT and 99%-tetrofosmin parathyroid scan. The parathyroid tumor was removed and confirmed as a parathyroid adenoma by pathology. After operation, the patient was treated with vitamin D and calcium in response to the resulting hungry bone syndrome. The intact PTH level returned to a normal range after the removal of the parathyroid adenoma (J Kor SOC Endocrinol 18:153-158, 2003).

갑상선 종양에서 thrombin receptor (PAR-1)의 발현 양상

박지영,목지오,김여주,박형규,김철희,변동원,서교일,유명희,조현득,오미혜,김상진 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.2

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각종 조혈모세포 근원별 CD34+ 양성세포율 및 혈구 집락배양의 비교

목지오,변재호,김숙자,전진우,원종호,백승호,서원석,홍대식,박희숙 대한조혈모세포이식학회 1996 대한조혈모세포이식학회지 Vol.1 No.1

목적: 각종 조혈모세포의 근원인 말초혈액(PB), 고용량 항암요법과 조혈성장인자 투여후 얻은 말초혈액(MPB), 골수(BM) 및 제대혈 (UB)의 단핵구를 이용하여 CD₃₄+ 세포양성율 및 각종 조혈전구 세포의 집락 형성능을 비교 관찰하고자 한다. 방법: flow cytometry와 anti-CD₃₄+ 단세포항체를 이용하여 각종 조혈모세포 근원의 CD₃₄+ 양성세포함유 정도를 측정하였고, 분리된 단핵구를 집락배양하여 CFU-GM, BFU-E, CFU-GEMM 및 HPP-CFC의 집락형성능을 관찰하였다. 결과: 1) 각 조혈모세포의 근원별 CD₃₄+ 양성세포의 분리 전후의 비교 CD₃₄+ 양성세포의 양성률은 고용량 항암요법과 조혈성장인자 투여후 얻은 말초혈액에서 3.46±0.72%로 가장 높았으며 골수와 제대혈에서 각각 1.78±0.86%과 1.53±0.43%으로 비슷하였으며 말초혈액에서 0.14%로 가장 낮았다. CD₃₄+ 세포를 분리하였을 때, 분리후 CD₃₄+ 양성세포는 제대혈액에서 96.99±1.95%로 가장 높았으며 고용량 항암요법과 조혈성장인자 투여후 얻은 말초혈액에서 72.54±14.06%, 골수에서 60.6±1.9%, 그리고 말초혈액에서 54%로 나타났다. 2)각 조혈모세포의 근원별 조혈전구세포의 집락형성 CFU-GM, BFU-E, CFU-GEMM 그리고 HPP-CFC를 사용한 집락배양결과 CD₃₄+ 양성세포 분리군에서 비분리군에 비해 집락수가 많았으며, CFU-GM의 경우 그 비는 말초혈액, 골수, 그리고 제대혈액에서 각각 112배, 10배, 5배, 26배 또한 CFU-GEMM은 각각 136배, 8배, 12배가 높았다. 결론: 각종 조혈모세포의 근원별 CD₃₄+ 양성세포의 양성세포율 및 조혈전구세포 집락배양비교시 CD₃₄+ 양성세포와 조혈전구세포가 말초혈액이나 골수보다 MPB나 제대혈에서 훨씬 많은 것을 관찰하였다. Background: Classically bone marrow is the major source of hemopoietic stem cells of the allo/autologous hemopoietic stem cell tansplantation. Recently, hemopoietic stem cells circulate in peripheral blood, "mobilized" with cytokines and/or cytotoxic chemotherapy and umbilical cord blood stem cells, are widly used for high dose chemotherapy with hemopoietic stem cells support. The aim of this study is to investigate the possibility of clinical applications of selected CD34+ cells with source of hemopoietic stem cells such as, peripheral blood(PB), mobilized PB(MPB), bone marrow(BM), and umbilical cord blood(UB) Methods: We evaluated the comparison of the clonogenicithy and percentage of CD₃₄+ cells according to each source of hemopoietic stem cells in before and after separation of CD₃₄+ cells through in vitro colony assay and flow cytometry with anti-CD₃₄+ monoclonal antibody. Results: 1) CD34+ cells were detected in PB, MPB, BM, and UB at incidences of 0.14%, 3.46 ±0.72%, 1.78±0.86%, and 1.53±0.43% of total mononuclear cells. And the most CD34+ cells were detected in UB after seperation of CD₃₄+ cells. 2) The colony counts revealed more in CD₃₄+ isolating group. Clonogenicity of CD₃₄+ cells in PB, MPB, BM, and UB was 112-fold, 10-fold, 5-fold, and 26-fold in colony forming unit-granulocyte and macrophage(CFU-GM), and 136-fold, 8-fold, 3-fold, and 12-fold in colony of forming unit-granulocyte, erythrocyte, monocyte, megakaryocyte(CFU-GEMM). The colony counts of UB and MPB were large numbers more than PB and BM. Conclusion: Clonogenicity and percentage of CD₃₄+ cells are superior MPB and UB than in PB and BM.

관동맥 조영술상 관동맥의 심근교 현상에 관한연구

권영주,목지오 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

BACKGROUND: Myocardial bridging is defined as embedment of a segment of the coronary artery into the myocardium so that during ventricular systole the segment of artery is compressed. The prevalance of myocardial bridges among consecutive patients coronary angiography varies between 0.5% and 16% with most studies reporting an incidence of less than 2%. Because any studies is not reported about myocardial bridging in Korea, this study was done to establish the angiographic evidence of myocardial bridging in cineangiograms performed in the cardiac laboratory of the Soonchunhang University PATIENTS AND METHODS: In the 10-years period between 1987 and 1996, selective coronary angiography was performed on 1079 patients at the Medical University of Soonchunhang Hospitals. All studies were reviewed and patients were divided into three groups on the basis of the degree of systolic compression: Mild(1-30% systolic compression). Moderate(31-50% systolic compression), and Severe(51-100% systolic compression). RESULTS: 1. 10 PATIENTS(0.93%) Were found to have myocardial bridge. and 9 patients had systolic compression of the left anterior descending coronary artery and one patient had compression of the right coronary artery. 2. Cineangiograms of all 292 "normal" patients who had symptomes suggestive of angina pectoris were reviewed and 7 patients(2.4%) were found to have myocardial bridging. 3. 4 patients had mild myocardial bridge, 1 patient had moderate, and 5 patients had severe. 4. The ECG was normal in 4 patients, showed left ventricular hypertrophy in 5 patients, and showed atrial fibrillation. Treadmill exercise test was positive in 5 patients, and non-diadnostic test due to insufficient exercise capacity was 5 patients. CONCLUSIONS: The angiographic incidence of myocardial bridges was noted was noted 0.93% and most common site is the left anterior descending artery.

포상기태(Hydatidiform mole)에 의해 발생된 심한 갑상선중독증 1예

이재학,박종근,권순효,목지오,윤지성,김여주,박형규,김철희,김상진,이해혁,남계현,권계현,고은석,변동원,서교일,유명희 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

저자들은 무월경의 11주의 27세 환자에서 심한 갑상선중독증을 동반하고, β-HCG가 1,123,0001U/L으로 크게 증가되었으나, 흡입소파술 시행후 임상 증상과 갑상선기능 그리고 β-HCG가 모두 정상으로 호전된 포상기태 (Hydatidiform mole) 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Human chorionic gonadotropin(HCG) is one of the glycoproteins families synthesized by the placenta, and consists of 2 noncovalently joined subunits, namely, α' and . The α' and -subunits have a structural homology with the α' and -subunits of TSH and LH. The thyrotropic action of HCG results from its structural similarity to TSH, so -HCG can bind to the TSH receptor in the thyroid gland. A high level of HCG, accompanied by an increased thyroid hormone level, can be observed in gestational trophoblastic diseases (GTD), such as a hydatidiform mole or a chorio- carcinoma. However, the clinical symptoms of hyperthyroidism in GTD are rarely observed. A 27-years-old woman, admitted due to an amenorrhea of 11 weeks duration, with thyrotoxic symptoms, such as weight loss, palpitation, sweating, tremor, heat intolerance and anxiety, was evaluated. Her serum free T4 level was 8 times higher than normal, and her serum -HCG level was over l,OO0,00OIU/L. She had a curettage operation, with the pathological findings of a complete hydatidiform mole. These thyrotoxic symptoms developed due to a hydatidiform mole, and were accompanied with a highly increased serum β-HCG level. After evacuation of the molar tissue, the thyroid hormone and thyrotoxic symptoms normalized. Here, this case is reported, with brief review of the literature (J Kor SOC Endocrinol 18:420425, 2003).