크로이츠펠트-야콥 병

구본대,신동익,한현정,나덕렬,,이상복 관동대학교 의과대학 의과학연구소 2005 關東醫大學術誌 Vol.9 No.1

Creutzfeldt-Jacob disease (CJD) is one of the fatal prion diseases. Diagnosis of CJD is mainly based on clinical symptomatology of established criteria, characteristic electroencephalogram, specific cerebrospinal fluid protein measurement, prion protein gene analysis, prion protein isoform detection, and neuropathology. But spongiform change of brain pathology is the only definitive diagnosis of CJD. Clinical symptomatology of CJD includes behavioral disturbances, progressive dementia, cerebellar, pyramidal, and extrapyramidal signs. Most patients show progressive myoclonic jerks that involve either limbs or the entire body. The approximate incidence of CJD is 1 per million and occurs as sporadic, familial and iatrogenic forms. Variant CJD has the strong possibility of cross species transmission between human and cow. It has some differences in clinical and pathological aspects from sporadic CJD. Protease resistant prion protein of scrape isoform may lead to diverse neuronal death in CJD. Recent advannces in CJD reveal that apoptosis, proinflammatory cytokine expression and oxidative stress may play an important role of CJD pathogenesis. There areseveral therapeutic trials in CJD but no therapeutic regimensshow effective results. Although there is much progression about CJD in recent days, a lot of things still remained to be reveled.

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.

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.

폐경후 골다공증 환자에서 체질량지수에 따른 Alendronate의 효과

조영석,나소영,이효진,홍우정,김군순,김도희,구본정,송민호,김영건,노흥규 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.2

배경 : 폐경후 골다공증은 심각한 문제로 대두되고 있다. 현재 Alendronate는 폐경후 골다공증의 치료제로서 널리 쓰이고 있다. 저자는 Alendronate의 골밀도에 효과를 알아보고 골다공증의 위험인자에 따른 Alendronate의 반응 정도를 평가하기 위하여 본 연구를 수행하였다. 방법 : Alendronate를 평균 12개월간 복용한 35명의 폐경후 골다공증환자에서 체질량지수와 폐경후 기간에 따른 치료효과를 조사하였다. 결과 : 전체 대상군에서 Alendronate 10㎎을 12개월간 투여한후 골밀도의 평균 변화율은 요추와 대퇴골 경부에서 각각 7.83±7.39%와 2.99±9.22%이었다. 과체중군에서 평균변화율은 요추와 대퇴골 경부에서 각각 7.15±4.5%와 3.05±2.86%였다. 양군간에 통계적 유의성이 있는 차이는 없었다. 폐경후 7년이 경과되지 않은 군에서의 평균변화율은 요추와 대퇴골 경부에서 각각 6.9±5.3%와 5.71±0.08%였다. 양군간에 통계적인 유의성이 있는 차이는 없었다. 결론 : 마른체형이 골다공증의 발병에는 영향이 있으나, Alendronate 치료효과의 차이는 없는 것을 확인할 수 있었다. 더불어 폐경이 있고 7년이 초과된 군과 년이 경과되지 않은 군에서의 Alendronate 치료효과의 차이는 없는 것을 확인할수 있었다. 이는 골흡수가 상당히 진행된 상태에서도 Alendronate가 치료효과를 가지고 있음을 반영한다고 할 수 있겠다. Postmenopausal osteoporosis is a serious health problem. The aminophosphonate Alendronate is widely used for treatment of postmenopausal osteoporosis. We studied the effect of l0㎎ of alendronate given daily for mean 12 months on bone mineral density in 35 women(mean age 61yrs. mean BMI 23.24㎏/m^(2)) with osteoporosis. An over weight group is defined such that BMI was above 23㎏/m^(2). All the women received 1500㎎ calcium carbonate daily. The bone mineral density of L-spine and femoral neck was measured by dual-energy X-ray absorptiometry. Alendronate increased BMD at mean 12 months at the L-spine (7.15±4.5%) and femoral neck(3.05±2.86%) in normal women. Alendronate increased bone mineral density at 12 months at the L-spine(6.00±5.3%) and femoral neck(4.17±4.87%) in overweight women. There was no difference between two groups. In the less than 7 years group of postmenopausal duration. alendronate increased bone mineral density at 12 months at the L-spine(6.9±4.9%) and femoral neck(3.18±7.1%). In the more than 7 years group of postmenopausal duration, alendronate increased hone mineral density at 1% months at the L-spine(6.5±5.3%) and femoral neck(5.71±0.08%). There was no difference between two groups. In postmenopausal women with osteoporosis, therapy with alendronate produced significant increases in BMD of the L-spine and femoral neck in both group. There was no difference between normal and over-weight groups. and between less than 7 years group and more than 7 years group of postmenopausal duration.

HMG-CoA 환원효소 억제제에 의한 ICAM-1 유전자의 발현조절

김현진,정효균,홍우정,김군순,조영석,김도희,채수흥,구본정,송민호,노흥규,김영건 충남대학교 의과대학 지역사회의학연구소 2001 충남의대잡지 Vol.28 No.1

Background : ICAM-1 act as one of major adhesion molecules in the atherosclerotic lesion. ICAM-1 expression is mainly regulated at the level of transcription and depend on IFN-γ signal transduction pathway in which the STAT1 transcrption factor is a critical intermediate. IFN-γreceptor not only initiates tyrosine 701 phosphorylation of STAT1 by Jak1 and Jak2, but also phosphorylates serine 727 through the activation of Raf-1/MAP kinases. HMG-CoA reductase inhibitors have anti-atherosclertic effects, beyond normalization of hypercholesterolemia, by directly acting on endothelial cells, macrophages and vascular smooth muscle cells. HMG-CoA reductase inhibitors suppress the synthesis of isoprenoid intermediates such as geranylgeranyl-pyrophosphate or farnesylpyrophosphate. These effects results inhibitors suppress the synthesis of isoprenoid intermediates such as geranylgeranyl-pyrophosphate or farnesylpyrophosphate. These effects results inhibition posttranslational farnesylation and geranyl-geranylation processing of small GTP-binding preoteins and inhibition of normal signaling activities. Method : We made several 5'-deletion constructs of rat ICAM-1 promoter and analyzed the promoter activities by measuring the luciferase activity after transfection into ECV304 cells and smooth muscle cells. We checked the level of total and phosphorylated STAT1 protein by immunoblot analysis using specific antibodies. Results : Lovastatin inhibits IFN-γ-induced ICAM-1 gene expression in the ECV304cell. The cells pretreated with PD98059, MEKK inhibitor showed significantly low ICAM-1 RNA induction with IFN-γ stimulatio. IFN-γ induced phosphorylation of tyrosine 701 was not significantly changed by the pretreatment of lovastatin. But lovastatin suppresses IFN-γ-induced phosphorylation of ERK1/ERK2 which are responsible for the seine 727 phosphorylation in STAT1. Conclusion : We showed that HMG-CoA reductase inhibitors, lovastatin, suppresses IFN-γ mediated ICAM-1 gene expression through the inhibition of transcription. HMG-CoA reductase inhibitor suppresses IFN-γ-induced phosphorylation of serine 727 in STAT1 through the modulation of MAP kinases.

양성 갑상선 결절에서의 무수 알코올 치료 효과

김도희,나소영,이효진,홍우정,김군순,조영석,구본정,송민호,김영건,노흥규 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1

목적 : 양성 갑상선 결절 환자에서의 PEI의 치료효과 및 부작용을 알아보고자 하였다. 방법 : 양성 갑상선 결절 환자 88명을 대상으로 초음파 소견에 따라 낭종성 결절, 복합성 결절, 고형성 결절 등 세 그룹으로 분류후 전체 및 각각에 대한 PEI의 치료효과 및 부작용을 조사하였다. 결과 : 양성 갑상선 결절 환자 88명을 PEI로 치료후 결절의 크기가 50%이상 감소한 경우는 전체 환자중 77.2%이었고 각 결절별로 살펴보면 고형성 결절에서 52.6%, 복합성 결절에서 72.4%, 낭종성 결절은 92.5%이었다. 부작용은 동통, 결절내 출혈, 감염, 결절의 누출등이 있었으나 대부분 무증상이었다. 결론 : PEI는 양성 갑상선 결절 환자증 적응증을 잘 살펴 고려해 볼 수 있는 치료법이라 생각되며 특히 낭종성 결절 환자에서 주사기에 의한 흡인후에 재발한 경우 일차적인 치료로 PEI를 고려해 볼 수 있겠다. Ultrasonography(US)-guided percutaneous ethanol injection (PEI) has been performed for the treatment of autonomous functioning thyroid nodules, thyroid cysts, & cold thyroid nodules. The author studied the efficacy of PEI in the treatment of benign cold thyroid nodules both solid and cystic (complex & pure). Eighty-eight euthyroid outpatients (age:44.2±13.9years, 75 women and 13 men) with benign cold thyroid nodules or simple thyroid cysts (69 with a single nodule and 19 with a prominent nodule within multinodular goiter) were includied in this study. After PEI, each subtype of thyroid nodules was divided into three groups in according to volume reduction complete response (90% or more of volume reduction), partial response (50% or more of reducton but below 90%), and failure (below 50% or increase in size) group. Overall response rates of PEI for benign thyroid nodules were complete 45(51.1%), partial 23(26.1%), failure 20(22.7%). In 20 cold solid nodules, complete response was observed in 6(30.0%), partial response in 5(25.0%), and failure in 9(45.0%). In 28 complex cysts, complete response was observed in 8(28.6%), partial response in 12 (42.9%), and failure in 8(28.6%). In 40 pure cysts, complete response was observed in 31(77.5%), partial response in 6 (15.0%), and failure in 3 (7.5%). Side effects comprised pain 8 (9.2%), intranodular bleeding 13 (14.6%), extracapsular leakage 1(1.1%), infection 1 (1.1%), increased size l(1.1%), and none 64(72.7%). PEI may prove a safe & effective tool for the therapy of cold thyroid nodules in selected cases and may be the treatment of choice of recurrent thyroid cysts. However, further investigation involving a larger number of patients and a longer follow-up is needed.

제 2형 당뇨병 환자에서 D-chiro-inositol의 혈당강하 효과

구본정 ( Bon Jeong Ku ),김현진 ( Hyun Jin Kim ),박강서 ( Kang Seo Park ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1

목적: DCI는 인슐린 신호전달 과정의 중간에 존재하는 물질로 당뇨병이 유발된 동물 모델에서 혈중 농도가 감소해 있으며, DCI를 투여했을 때 인슐린 저항성이 개선되고 혈당이 정상화됨이 알려져 있다. 당뇨병 환자에게 DCI를 투여했을 때는 인슐린 저항성의 개선을 통하여 혈당조절에 효과가 있다는 보고도 있고 반대의 경우도 있어 당뇨병에 대한 DCI의 효과를 정확히 알 수 없었다. 따라서 연구자들은 제2형 당뇨병 환자에게 DCI를 투여하여 혈당강하 효과를 알아보고 또한 안전성을 평가하였다. 방법: 2005년 3월부터 8월 사이에 을지대학병원 내분비대사내과에 내원하여 치료받은 제2형 당뇨병 환자 82명을 대상으로 무작위, 이중맹검, 위약병행 연구를 시행하였다. 혈당조절 효과를 평가하기 위한 주평가지표는 당화혈색소 개선량이었으며, 그 외에 부평가지표는 공복 혈당 개선량 및 식후 2시간 혈당 개선량이었다. 안전성을 평가하기 위해 전체 대상군에서 나타난 이상반응 및 발현율을 분석하였다. 결과: 연구에 참여한 총 82명 중 선정기준에 부합되는 66명을 피니톨군과 대조군으로 각각 33명씩 배정한 후 시험제제(피니톨 1,200 mg) 또는 위약이 12주간 투여되었으며, 동의철회로 중간에 탈락된 5명을 제외하고 임상시험을 완료한 환자는 피니톨군 31명, 대조군 30명이었다. 임상시험 전 인구학적 특징이나 신체계측, 그리고 검사실 소견에서 양 군 사이에 통계적으로 유의한 차이는 없었다. 임상 시험 종료 후 시행한 검사에서 당화혈색소와 공복 혈당은 피니톨군과 대조군 사이에 통계적으로 유의한 차이가 있었으며, 식후 2시간 혈당은 차이가 없었다. 임상시험 전에 측정한 당화혈색소 값에 따라 8% 미만인 군과 이상인 군으로 나누었을 때, 당화혈색소가 8% 이상인 군에서만 당화혈색소와 공복 혈당의 개선이 통계적으로 유의하게 있었다. 이상반응은 피니톨군에서 9명, 대조군에서 7명이 발생했으나 양 군 사이에 유의한 차이는 보이지 않았으며, 임상적으로 문제가 되는 중대한 이상반응은 없었다. 결론: 피니톨은 경구혈당강하제로 치료 중인 제2형 당뇨병 환자에서 혈당조절 효과가 있으며, 특히 당화혈 색소 값이 8% 이상인 환자군에서 혈당조절을 하는데 더욱 효과적이었다. 또한 피니톨을 투여했을 때 중대한 이상반응이 발생하지 않으며 안전함을 확인하였다. Background: D-chiro-inositol (DCI) is a postreceptor signaling molecule of insulin action. Blood and urine levels of DCI were decreased in diabetic animals. Treatment of DCI improves insulin resistance and normalizes blood glucose level in diabetic animals. In diabetic patients, treatment of DCI has a effect of glucose control in some study but not in others. So we study to confirm the effect and to evaluate the safety of DCI by the use of pinitol, methyl derivates of DCI. Methods: We performed a randomized, double-blind, placebo-controlled study in 82 patients with type 2 diabetes mellitus who visited the Eulji University Hospital from March 2005 to August 2005. We checked the change of HbA1c, FBS, and PP2 to evaluate pinitol effect of sugar control. And also we checked the effect of pinitol treatment to evaluate safety. Results: We treated with either pinitol or placebo for 12 weeks in 66 patients and completed the study in 61 patients. There are no difference in the basal clinical or laboratory data between the pinotol and control groups. In the pinitol group there more decrease in the levels of HbA1c and in fasting blood glucose than in control group after 12 weeks study. When we performed subgroup analysis, in patients with a HbA1c level above 8% there was a more effectively respond to pinitol treatment. Than in less no significant side effects was occurred. There are no differences in side effects seen between the two groups. Conclusions: Treatment of pinitol was effective and safe in type 2 diabetic patients who received oral hypoglycemic agents. This is especially seen in patients with a high HbA1c level (>8%). (Korean J Med 72:29-36, 2007)

당뇨병성 망막증의 역학

구본정 ( Bon Jeong Ku ) 대한당뇨병학회 2009 임상당뇨병 Vol.10 No.3

상자재배시 EC 및 용토가 절화용 수국의 생육과 개화에 미치는 영향

구본순(Bon-Soon Ku),조문수(Moon-Soo Cho),이정일(Jeong-Il Lee),양현모(Hun-Mo Yang),정하정(Ha-Jeong Jeong),이희두(Hee-Doo Lee),김주형(Ju-Hyoung Kim) 한국원예학회 2010 한국원예학회 학술발표요지 Vol.2010 No.5