인슐린비의존형 당뇨병환자에서 허혈성 심장질환의 선별검사로서 관상동맥 칼슘침착수치 측정의 유용성

임승길(Sung Kil Lim),이종호(Jong Ho Lee),이현철(Hyun Chul Lee),송영득(Young Duk Song),김경래(Kyung Rae Kim),허갑범(Kap Bum Huh),윤용석(Yong Seok Yun),이유미(Yu Mie Rhee),심대근(Dae Keun Sim),신성관(Sung Kwan Sin),박병규(Byung Ku Park 대한내과학회 1999 대한내과학회지 Vol.56 No.3

N/A Patients with NIDDM are at increased risk for the development of coronary atherosclerosis and experience more silent myocardial infarction than non-diabetic subjects. The screening tools for early detection of coronary artery disease without significant narrowing has been requested in diabetic patients. Coronary artery calcification (CAC) score, quantified by electron beam computed tomography (EBT), have been reported to correlate with the amount of atherosclerotic plaque and vascular luminal narrowing. We investigated the distribution of CAC score and associated risk factors in asymptomatic NIDDM patients and patients with ischemic heart disease to estimate the usefulness of CAC as a screenig tool for ischemic heart disease in asymptomatic diabetes. Method : 136 NIDDM patients without any symptom of coronary artery disease and 37 patients with significant coronary artery stenosis were included. CAC were measured by electron bean tomography (ultrafast CT). Forty contiguous 3-mm thickness transverse two-dimensional sections were obtained through root of aorta and heart. Coronary calcification were defined as the presense of at least two adjacent pixel within the border of visualized coronary artery with CT number of at least 130 HU. Body mass index, waist-hip ratio were measured and body fat components were counted by impedence method. Visceral fat versus subcutaneous fat ratio were calculated by abdominal computed tomography. Plasma lipid profile, fasting insulin, C-peptide level, HbA1c concentration were measured. Correlations between natural log of CAC score and clinical parameters were evaluated and multiple regression analysis with natural log of CAC score as a independent variable was performed. Coronary angiography were performed in 17 asymptomatic NIDDM patients.. Result : CAC score was significantly higher in male than female subjects and increased significantly with aging (p<0.01). In patients with hypertension, previous history of cerebrovascular or peripheral vascular disease (p<0.05), CAC score was significantly increased. The CAC score showed significant positive correlations with smoking amount, duration of diabetes and a negative correlation with HDL-cholesterol (p<0.05). There were no association between CAC score and total cholesterol, LDL-cholesterol, waist to hip circumference ratio, or fasting insulin levels. After adjustment of compounding variables (age, sex), duration of diabetes, amount of smoking and previous history of atherosclerotic vascular disease were shown to be associated with CAC score. In multiple logistic regression analysis with natural log of CAC score as dependent variable, age, HDL-cholesterol, duration of diabetes, male gender were found to be significant independent variables. Seventeen diabetic patients with high CAC score, were taken coronary angiography and significant luminal narrowings (more than 50%) of coronary artery were documented in 16 patients. But, In 7 out of 17 patients with coronary one-vessel disease, coronary calcification were not detected by EBT. Conclusion : coronary artery calcium score quantified by electron beam computed tomography may be useful for screening of preclinical or asymptomatic coronary artery disease in asymptomatic NIDDM patients.

한국 여성골조송증환자들에서 보인 골조송증 위험인자 ( 예보 )

임승길(Sung Kil Lim),정현철(Hyun Cheol Chung),이미경(Mi Kyung Lee),김현만(Hyeon Man Kim),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh),김남현(Nam Hyun Kim),박병문(Byeong Mun Park) 대한내과학회 1988 대한내과학회지 Vol.34 No.4

N/A We evaluated the risk factors of osteoporosis in thirty-eight osteoportic women and 38 age-matched control women. We employed a sensitive technique of dual photon absorptiometry to measure bone mineral density, and the osteoporsis was defined when the bone mineral density of the patients was below -2 standard deviation of decade-and sex-matched control value. The patients group showed relatively low frequency of full term delivery, and less daily activity, They also tended to show dietary deficiency of calcium, protein, vitamin-C, and longer duration of menopause. Meanwhile, anthrophometric measurements, frequency of pregnancy and breast-feeding, amouot of caffeine intake, smoking and alcohol drinking are not significantly differerent between the two groups. In conclusion, the subjects with such risk factors in addition to known secondary cause of osteoporosis need a screening test for detecting osteoporsis and the medical advice of hormonal replacement and exercise should be encouraged for the subjects of impending osteoporosis.

일차성 남성 골다공증의 원인 및 임상적 특성

임승길(Sung Kil Lim),이용호(Yong Ho Lee),이현철(Hyun Chul Lee),송영득(Young Duk Song),허갑범(Kap Bum Huh),김미경(Mi Kyung Kim),장준호(Jun Ho Jang),남재현(Jae Hyun Nam),안철우(Chul Woo Ahn) 대한내과학회 1999 대한내과학회지 Vol.57 No.3

N/A Osteoporosis in men has recently been recognized as an important public health problem. In women, pathophysiology, risk factors, etiology and treatment of osteoporosis have become well defined. However, less information has been availabe concerning men until now. Male osteoporosis has been known to be associated with drugs and diseases that threaten bone health. However, the causes of male osteoporosis are not apparent in some instances. This study was designed to evaluate the clinical characteristics and causes of primary osteoporosis in Korean men. Methods : The BMD was measured with DEXA in 327 healthy adult Korean men who were employed by the same company in Seoul. Among them, we studied 20 patients who visited the department of internal medicine at Yonsei University Medical Center for evaluation of osteoporosis. Osteoporosis was defined by WHO criteria for women. We performed history taking, physical examination, nutritional assessment and laboratory examination. Results : The mean age of patients was 52 years. None of them have taken corticosteroid or any other medicine. None of them had suffered from any other medical illness. The mean BMI was 22.1 kg/m2 and the values of 7 patients were less than the age-matched normal value of healthy Korean men. Six patients were current smokers and there were no heavy drinkers. Urinary calcium excretion was elevated in 5 patients and dietary calcium intake was less than 400mg/day in 4 patients. Vitamin D deficiency, as evidenced by serum 25(OH) D levels below 12 ng/mL, was detected in 2 patients, however, subclinical hypovitaminosis D (below 20 ng/mL) was observed in 8 patients. Serum free testosterone levels below normal value were observed in 5 patients. The mean serum IGF-I level was 183.7 ng/mL and that was lower than for normal Korean men. Lower IGF-I levels than age-matched normal values were observed in 5 patients. Conclusion : The clinical characteristics of Korean male osteroporosis were heterogenous in many aspects of its features. Several factors could be suggested as possible causes of idiopathic male osteoporosis. Men with osteoporosis in this study revealed low BMI(7 patients), family history of osteoporosis(1 patient), low calcium intake(4 patients), hypercalciuria(5 patients), Vitamin D deficiency(2 patients), subclinical hypovitaminosis D(8 patients), testosterone deficiency (5 patients) and low IGF-I level(5 patients). Multiple causes of osteoporosis were found in 6 patients. (Korean J Med 57:304-312, 1999)

대학운동선수의 견관절 복합체의 관절가동범위와 내,외회전력

임승길(Seung Kil Lim),김홍인(Hong In Kim),공성아(Sung Ah Kong),이신언(Shin Eon Lee) 한국사회체육학회 2006 한국사회체육학회지 Vol.0 No.27

이달의 엑스선 사진 : Neurofibromatosis 환자에서 병발된 삼출성 흉막염 및 우측흉벽에 생긴 종괴

하성규 ( Sung Kyu Ha ),임승길 ( Seung Kil Lim ),김성규 ( Sung Hyu Kim ),김태승 ( Tae Seung Kim ),심호식 ( Ho Shik Shim ) 대한결핵 및 호흡기학회 1982 Tuberculosis and Respiratory Diseases Vol.29 No.4

당뇨병환자에서 식도운동에 관한 연구

이상인(Sang In Lee),이관우(Kwan Woo Lee),임승길(Seung Kil Lim),이현철(Hyun Chul Lee),문영명(Young Myoung Moon),최흥재(Heung Jai Choi) 대한내과학회 1988 대한내과학회지 Vol.34 No.3

N/A Esophageal manometry was performed in 10 diabetics with neuropathy, 11 diabetics without neuropathy and 11 healthy controls using low compliance pneumohydraulic capillary infusion system before and after infusion of edrophonium (80 ㎍/kg) and atropine (3 ㎍/kg). The results were summarized as follows: 1) Basal lower esophageal sphincter pressure and relaxation in diabetics were similar to that of healthy controls. 2) There were no significant differences in the amplitude, duration and velocity of peristaltic wave between diabetics and controls. 3) Multipeaked peristaltic waves were observed in 9 of 10 diabetic patients with neuropathy and more than quadriple peaked waves were 30%. Multipeaked peristaltic pressure complexes in control differed from those present in diabetics with neuropathy by their low incidence and by a tendency to be limited to the distal esophagus. In conclusion, multipeaked peristaltic pressure waves were the significant manmometric finding in diabetics with neuropathy and phamacologic response to edrophonium and atropine suggested the increased cholinergic tone.

증례 : 두 종류의 항체를 보유한 자가면역성 저혈당 1예

전성완 ( Sung Wan Chun ),이병완 ( Byung Wan Lee ),강은석 ( Eun Seok Kang ),차봉수 ( Bong Soo Cha ),이은직 ( Eun Jig Lee ),임승길 ( Sung Kil Lim ),이현철 ( Hyun Chul Lee ) 대한당뇨병학회 2009 임상당뇨병 Vol.10 No.2

자가항체로 인한 고인슐린성 저혈당증을 특징으로 하는 자가면역 저혈당은 인슐린 자가면역 증후군과 B형 인슐린저항성으로 나뉘며, 서로 다른 임상적 특성을 보인다. 저자들은 glucocorticoid 치료에 반응하지 않는 자가면역성 저혈당증에 대해 두 가지 종류의 인슐린 항체가 함께 존재함을 확인하고 cyclophosphamide 충격요법으로 저혈당이 호전된 73세 여자 환자 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Autoimmune hypoglycemia is rare kind of autoimmune disease caused by either anti-insulin antibodies (insulin autoimmune syndrome, IAS) or anti-insulin receptor antibodies (type B insulin resistance, type-B IR). We experienced an extremely rare case of the IAS accompanied by type-B IR. A 73-year-old woman presented with recurrent severe hypoglycemic symptoms at dawn for one month was admitted to the Severance hospital. She had several medical histories including 30 years of hypertension, 15 years of type 2 diabetes, and 4 years of coronary artery disease before admission. She had never received an insulin injection. Hypoglycemia was diagnosed at 10 hours in the 72-hour fasting test with glucose, insulin, and C-peptide levels of 42 mg/dL, 280.31 μU/mL, and 7.70 ng/mL, respectively. The insulin autoantibody titer was 130 μU/mL and quantitative assay for insulin receptor antibody was positive. Insulinoma was ruled out by imaging techniques and calcium stimulation test. She has no evidence of other diseases associated with altered immunity. Despite of treatment with prednisolone, symptomatic hypoglycemic events persisted at fasting state. Early induction of 300 mg cyclophosphamide therapy resulted in remission of hypoglycemia accompanied by suppressed antibody titer. The changes in autoantibodies might result in alleviation of the symptoms of hypoglycemia and improvement in insulin and C-peptide levels. (Korean Clinical Diabetes J 10:123-128, 2009)

한국인 당뇨병에 있어서의 췌도세포 항체에 대한 연구

조용욱(Yong Wook Cho),임승길(Sung Kil Lim),김현만(Hyeon Man Kim),이영식(Young Sik Lee),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh) 대한내과학회 1987 대한내과학회지 Vol.33 No.6

N/A There are several reports indicating that ICA is important marker of persistent islet cell damage. It has been suggested that the presence of ICA in patient with NIDDM implies a high risk of future insulin dependency. Islet cell antibody (ICA) was determined by the indirect immuno fluorescence technique in 9 insulin dependent diabetes mellitus (IDDM), 12 atypical diabetes, 49 under-weight non-insulin dependent diabetes mellitus (NIDDM), 106 non-obese NIDDM, 45 obese NIDDM and 67 non-diabetic controls. We obtained the results as follows; 1) The prevalence of ICA was 0% in non-diabetic control and 14.9% in overall diabetes; 44.4% in IDDM, 41.7% in atypical diabetes, 22.4% in underweight NIDDM, 11.3% in non obese NIDDM and 2.2% in obese NIDDM. 2) In IDDM and atypical diabetes, 75% (3/4) and 60% (3/5), respectively, had short duration of diabetes (less than 1 year). However, in NIDDM patients with ICA, 87.5% (21/24) had the duration of disease more than 3 years. 3) In atypical diabetes and underweight NIDDM with ICA, the basal and peak C-peptide levels were significantly lower than in those without ICA. 4) Most of diabetics with ICA needed insulin for control of diabetes. These data indicated that atypical diabetes is similar to IDDM and high prevalence of ICA in underweight may reflect the early stage of IDDM and destruction of beta cell.

당뇨백서에서 췌장도세포 동종이식에 대한 Cyclosporin 효과

이현철(Hyun Chul Lee),임승길(Sung Kil Lim),김경래(Kyung Rae Kim),허갑범(Kap Bum Huh),박기일(Ki Il Park) 대한내과학회 1988 대한내과학회지 Vol.35 No.6

N/A Although pancreatic islet transplantation is a promising approach to avoiding the problems of segmental grafting, these are several difficulties to overcome. One of these problems is the rejection process. It is striking that Cyclosporin A, while providing a significant prolongation of allograft survivals in segmental pancreatic transplants, seems to be less effective for islet grafts, especially those transplanted across a major his-tocompatible barrier. We have investigated, in an al-logenir rat model, whether two donor-one recipient transplants show improved graft survival time using cyclosporin A as an immunosuppressant. The results obtained were as follows: 1) Using the procedure of collagenase digestion/Ficoll density gradient, 200-600 islets could be isolated from one donor. 2) Six recipient rats which had been treated with cyclosporin A were successfully transplanted. The other rats remained normoglycemic for 8 to 12 weeks. 3) Four of 5 recipient rats which had not been treated with cyclosporin returned to a state of hyperglycemia within 5 days after transplantation. Only one rat remained normoglycemic for 12 weeks. 4) Intraperitoneal glucose tolerance tests in successfully transplanted rats showed normal glucose tolerance levels and the insulin responses to glucose change were similar to those of the control rats. 5) In histologic tests performed 2 weeks after successful transplantation, islet cells were found in terminal portal venule and liver parenchyma. In conclusion, an immunosuppressive effect of cyclosporin could be demonstrated in our experments, and this seems to be very useful for islet allogenic transplantation.

고 Prolactin 혈증 환자의 골밀도

이미경(Mi Kyung Lee),임승길(Sung Kil Lim),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh),장상섭(Sang Sub Chung),이규창(Kyu Chang Lee),박기현(Ki Hyun Park),박찬규(Chan Kyu Park) 대한내과학회 1988 대한내과학회지 Vol.35 No.2

N/A Hyperprolactinmia is a relatively common clinical problem occurring in more than 25 percent of women who have secondary amenorrhea. Previous studies of hyperprolactinomic women suggested an association with decreased cortical bone density. To determine whether hyperprolactinemia is associated with reduced bone mineral density, we measured the bone mineral density of the vertebrae, femoral neck, and Ward's Triangle by dual photon absorptiometry in 18 hyper-prolactinemic patients, The bone mineral density for each patient fell almost within ±2 standard deviations of the mean for the decade-matched normal subjects. The prevalence of osteoporosis was 28% in hyperprolactinemic patients. The mean duration of amenorrhea in patients with osteoporosis was significantly longer than that in patients without oseteoprosis, 10±5 year, 5±6year, respectively (p<0.05). The mean estradiol level was not significatly different between the oteoporotic and nonoteoporotic groups. There was no significant difference in the pitutiary reserve function between the osteoporotic and non-oseoportoic groups, In patients who under- went surgery, radiotherapy and treatment with bromocryptine, the bone mineral density was relatively lower than that of patients treated by surgery and bromocryptine, or bromocryptine only. It is concluded that hyperprolactinemia is associated with reduced bone mioeral density, which is inversely related to the mean duration of amenorrhea.