폐경 여성에서의 오메가-3 지방산

김태희 ( Tae Hee Kim ),변동원 ( Dong Won Byun ),박용순 ( Yong Soon Park ) 대한폐경학회 2012 대한폐경학회지 Vol.18 No.2

폐경은 여성의 성호르몬 변화가 일어나는 중요한 변환기이다. 많은 여성들은 폐경 후 발생할 수 있는 열성홍조, 야간발한, 정신적 증상, 골다공증 심혈관계 질환, 골다공증, 비뇨생식기계의 위축 등과 같은 증상들로 인해 걱정하고 있다. 폐경 여성을 위해 식품과 대체 치료가 도입되고 있으며 점차 평균 수명이 증가하면서 폐경 여성의 관리는 공공 건강부분의 관리에 중요한 부분이다. 오메가-3와 오메가-6는 잘 알려진 필수 지방산이나 인간을 포함한 거의 모든 포유동물에서 식이를 통해서만 섭취가 되는 물질이다. 오메가-3 지방산은 폐경 후의 문제와 질환의 완화를 위해서 보완적인 대체로서 나타나게 되었다. 폐경 후의 증상 완화를 위한 대체 치료나 식습관의 변화 중에서 우리는 오메가-3의 역할과 효과에 대한 최근의 경향을 분석하여 보고하고자 한다. Menopause is a turning point in women that is based on the sex hormone change. Many women are very conscious about the postmenopausal period. After menopause, women complain about vasomotor symptoms, night sweat, psychological problems, osteoporosis, cardiovascular disease and urogenital symptoms. Nowadays, food and alternative treatment for postmenopausal symptoms are introduced. The average life span is now increasing, and postmenopausal care is important for public health. Long chain omega-3 and omega-6 fatty acids are known as essential fatty acids, however, all mammals, including humans, should obtain them from their diet. Omega-3 fatty acids have emerged as an adjuvant and alternative source for relieving postmenopusal complains or disease. Among alternative treatment or food behavior change for postmenopusal symptoms, we will review the current issues on the relationship between the role and the effect of omega-3 fatty acids in relieving postmenopausal symptoms.

증례 : 내분비-대사 ; 림프절 결핵완치 후 갑상선 결핵으로 재발된 1예

유희용 ( Hee Yong Yoo ),정철호 ( Chul Ho Chung ),노미오 ( Mi Oh Roh ),박형규 ( Hyeong Kyu Park ),변동원 ( Dong Won Byon ),서교일 ( Kyo Il Suh ),유명희 ( Myung Hi Yoo ) 대한내과학회 2009 대한내과학회지 Vol.77 No.6

결핵의 유병률이 높은 국내에서 갑상선 결핵은 드물고, 속립성 결핵의 갑상선 침범이나 갑상선 결절, 갑상선염, 농양 또는 갑상선암이 의심되어 갑상선 절제 후 갑상선 결핵으로 진단되어 항결핵제로 치료한 경우가 대부분이다. 저자들은 6년 전 경부 림프절 결핵으로 항결핵제를 복용한 후 완치판정을 받은 32세 여자 환자에서 갑상선 종괴가 우연히 발견되어 미세침흡인세포 검사를 통해 항산균을 확인하고 갑상선 결핵으로 진단한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Thyroid tuberculosis is rare, and primary tuberculosis is extremely rare. In most cases, thyroid tuberculosis presents as a thyroid nodule, thyroiditis, thyroid abscess, or thyroid cancer, and is often diagnosed after thyroidectomy. We experienced a case of thyroid tuberculosis that presented as a palpable thyroid nodule in a 32-year-old female patient. The patient had been previously diagnosed with cervical tuberculous lymphadenitis and had been treated successfully 6 years ago. Fine needle aspiration of the thyroid gland showed a small number of neutrophils and macrophages in a necrotic background, and many acid-fast bacilli were found with AFB staining. The patient began anti-tuberculosis therapy as an outpatient and is currently being followed regularly. Here, we report a case of thyroid tuberculosis diagnosed after the apparent cure of cervical lymph node tuberculosis. Additionally, a review of the literature is included. (Korean J Med 77:771-774, 2009)

만성 심낭삼출 환자에서 심낭천자 전후 심초음파 및 도플러 심초음파 소견의 변화

이규락 ( Lee Gyu Lag ),김영석 ( Kim Yeong Seog ),이충석 ( Lee Chung Seog ),한세환 ( Han Se Hwan ),손진휘 ( Son Jin Hwi ),변동원 ( Byeon Dong Won ),박노춘 ( Park No Chun ),이성우 ( Lee Seong U ),김성구 ( Kim Seong Gu ),권영주 ( Kwo 대한내과학회 1993 대한내과학회지 Vol.44 No.6

연구배경 : 심낭삼출에 의해 심낭압진이 발생되면 심장압박에 의해 심초음파도상 심방과 심실벽의 운동이상이 관찰되고, 도플러 심초음파도상 심장 각 부위에 혈류장애가 생길 것으로 예상된다. 이러한 변화는 환자의 호흡상태나 혈역학적 변화정도에 따라 다르게 나타난다. 방법 : 심낭삼출 환자에서 심낭천자전 M형 및 이면성 심초음파도와 심장 각 부위에서 도플러 심초음파도를 시행한후 심낭천자 및 우심도자를 동시에 시행하여 삼출액을 연속적으로 배출하면서 혈역학적 변화를 관찰하였다. 심낭삼출액을 완전히 배출후 다시 심초음파 및 도플러 심초음파를 시행하여 심낭천자전의 지표들과 비교하였다. 결과 : 1) 심초음파도 상 심낭천자후의 우심실벽 및 심실중격운동은 천자전과 비교하여 의의있게 감소하였다. 2) 우심실의 함몰소견은 11예중 8예에서 관찰되었으며 평균 심낭압이 높았던 군에서 더 많이 관찰되었다. 3) 천자후 도플러 심초음파도의 승모판 혈류는 천자전과 비교하여 A파 속도 및 A FVI는 감소하였고 E와 A의 비는 증가하였다. 결론 : 만성 심낭삼출 환자의 심초음파 검사에서 우심방 및 우심실의 비정상 운동은 혈역학적 장애가 심한 군에서 관찰될 것으로 기대된다. 도플러 심초음파도 상 승모판 혈류의 변화는 심낭삼출에 의해 좌심실벽 탄성이 감소되어 생기는 것으로 사료된다. Background : Echocardiography lacks accuracy in assessing the extent of the hemodynamic compromise produced by a pericardial effusion and has been unreliable for diagnosing cardiac tamponade. Recent reports suggest that there is an abnormality of right heart free wall motion in diastole by echocardiography and an increased respiratory variation in transvalvular flow velocities recorded by pulsed wave doppler examination. Methods : M mode, 2-Dimensional and Doppler echocardiographic examinations were performed in 11 patients with chronic pericardial effusion before and after pericardiocentesis. Right heart catheterization and monitoring of intrapericardial pressure were performed before and during serial fluid drainage. Results : 1) Right ventricular free wall motion and inter-ventricular septal motion in M mode echocardiography were significantly decreased after pericardiocentesis. 2) Eight patients had evidence of right ventricular diastolic collapse on the M mode and 2-Dimensional echocardiography. 3) Doppler transmitral indexes of left ventricular filling, consisting of a decreased in the peak early/late diastole (E/A) velocity ratio and an increase in the A area/mitral flow velocity integral ratio, suggest a decreased in the left ventricular compliance. Conclusion : Doppler echocardiography may be a valuable tool in the diagnosis of hemodynamic changes in patients with pericardial effusion.

폐경 쥐 모델에서 두류 섭취에 따른 자궁의 비타민 D 수용체의 발현

김태희 ( Tae Hee Kim ),박준식 ( Jun Sik Park ),이해혁 ( Hae Hyeog Lee ),이우석 ( Woo Seok Lee ),정수호 ( Soo Ho Chung ),박용순 ( Yong Soon Park ),변동원 ( Dong Won Byun ) 대한폐경학회 2013 대한폐경학회지 Vol.19 No.1

Objectives: Phytoestrogen-containing pulse supplements have beneficial effects on postmenopausal symptoms, but how such effects are achieved is unclear. This study investigates the effects of pulse consumption on the menopausal changes in ovariectomized rats. Methods: Female Sprague-Dawley rats were either sham operated (Sham; n = 3) or surgically ovariectomized (n = 13). The Sham group was fed the regular AIN-93M diet. Ovariectomized group was divided into 3 sub-groups and fed AIN-93M containing soybean (n = 5), mung bean (n = 3), or cowpea (n = 5) for 10 weeks. At the end of the experiment, all rats were sacrificed, and the uterus was harvested, rinsed, and weighed. Expressions of vitamin D receptor (VDR), estrogen receptor (ER) β, and ezrin in uterus were evaluated by immunohistochemistry. Results: VDR was highly expressed in the uterus of rat, irrespective of ovariectomized state. VDR was more definitely expressed in the uterus of ovariectomized groups than the sham-operated group. There were no significant differences in expression of ER β. However the expression of ezrin was highly expressed in the cowpea group compared to sham group (P = 0.044). Conclusion: This study suggested that legumes diet may concern menopausal changes via VDR and ezrin. The result may partly explain the beneficial effects of VDR on menopausal symptoms. Further study is necessary to study the detailed mechanisms of VDR and ezrin on the menopausal changes in the uterus. (J Korean Soc Menopause 2013;19:1-8)

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)

일차성 부갑상선 기능항진증으로 인한 모든 합병증이 동반된 부갑상선 종양 1예

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

Most of the primary hyperparathyroidism is resulted 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 causing brown tumor. Author experienced a case of 81-year-old man showing all complications of primary hyperparathyroidism. The patient presented with decreased mentality, acute gastric ulcer, acute duodenal ulcer, GB stones with cholecystitis, renal insufficiency, previous history of 3 times of renal stones, depression and osteoporoid Serum calcium level was 16.7㎎/dl and intact parathyroid hormone level was 3,901pg/ml. Parathyroid mass was detected by neck CT and 99mTc-tetrofosmin parathyroid scan. Parathyroid tumor was removed and confirmed as a parathyroid adenoma by pathologic finding. After operation, the patient was treated with vitamin D and calcium because hungry bone syndrome was occured, Intact PTH level was also returned to normal ranges after of parathyroid adenoma.

개원의를 위한 모범처방전:골다공증 환자의 처방

변동원 대한내과학회 2002 대한내과학회지 Vol.62 No.4

골다공증 치료의 최신약제들

변동원 순천향의학연구소 2008 Journal of Soonchunhyang Medical Science Vol.14 No.1

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High Performance Liquid Chromatography를 이용한 Hemoglobin A1C 측정

변동원,서교일,유명희,김극배 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.2

Hemoglobin AIc(HbAlc) has been known to be an index of long-term glycemic control (6-8weeks), and offers several practical advantages for screening of diabetes mellitus and evaluation of effects of treatment. Authors introduced to measure and investigate HbAlc levels by high performance liquid chromatoraphy (HPLC ; LDC Milton Roy, USA), with cation exchange column, Mono S HR 5/5 (Pharmacia). The results were as follows; 1. The mean HbAlc level in normal adult control group (n=50) was 4.13±0.25% (Mean±S.D). 2. Within-run precisions of HbAlc levels measured by HPLC were 4.39±0.01% (Mean±S.D.), 1.41(C.V.) in normal control, and 8.95±0.02% (Mean±S.D.), 1.65(C.V.) in intermittently treated diabetic patients, and 11.02±0.01% (Mean±S.D.) 2.93(C.V.) in untreated diabetic patients. 3. Between-run precision of HbAlc levels measured by HPLC were 4.35±0.01% (Mean±S.D.), 2.76(C.V.) in normal control, and 8.98±0.01% (Mean±S.D.), 1.22(C.V.) in intermittently treated diabetic patients, and 10.95±0.15% (Mean±S.D.), 3.51(C.V.) in untreated patients. 4. The peak level of HbAlc was obtained in about 9 minutes and the whole program could be completed within 17 minutes. 5. Blood specimens could be stored for as long as 8 days at 4℃ without changes of HbAlc levels. These results suggest that the measurement of HbAlc by HPLC using cation exchange column is so accurate, simple and rapid that the clinical use is more wider.

노인성 골다공증의 치료 및 관리

변동원 순천향의학연구소 2008 Journal of Soonchunhyang Medical Science Vol.14 No.2

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