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강보라미,정우철,이강문,백창렬,이지민,전효신,전경화,진형민 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.6
Eosinophilic gastroenteritis is an unusual disease that is associated with various clinical gastrointestinal manifestations. Its severity depends on the area involved as well as the wall layer involved. Eosinophilic gastroenteritis often causes abdominal pain, nausea, vomiting and diarrhea. To date, there has been an extremely rare case of eosinophilic gastroenteritis with systemic symptoms, such as fever or lymphadenopathy (LAP). We experienced a case of a 68-year-old-woman with fever and abdominal pain. Abdominal computed tomography revealed diffuse wall thickening of the gastric antrum as linitis plastica. Multiple hot uptakes of lymph nodes were visualized on fludeoxyglucose-positron emission tomography. The gastric biopsy pathological report demonstrated eosinophilic infiltration without malignant cells. We could not exclude malignancy and performed an exploratory laparoscopy. A lymph node specimen showed reactive hyperplasia, and her illness was finally diagnosed as eosinophilic gastroenteritis. Herein, we report the case with a brief review. 호산구 위창자염은 비교적 드문 질환으로 다른 원인 없이 위장관에 호산구의 침윤을 특징으로 한다. 여러 가지 임상증상이 나타나는데 주로 복통, 설사, 오심 및 구토이고, 침범하는 기관이나 발생한 병변에서 호산구가 침윤되는 범위에 따라 다르게 나타난다. 현재까지 발열이나 림프절 병증과 같은 전신 증상을 동반하는 호산구 위창자염은 매우 드물다고 알려져 있다. 저자들은 68세 여자에서 발열과 복통으로 발현한 호산구 위창자염을 경험하였다. 복부 CT에서 위전정부의 벽 비후 소견을 보였고, PET에서 다수의 림프절 종대와의 FDG의 고섭취가 관찰되었다. 상부위장관내시경을 통한 위 점막의 조직검사에서 악성세포는 보이지 않았지만 다수의 호산구 침윤을 관찰할 수 있었다. 위의 악성 종양을 배제하기 위하여 시험적 복강경을 통한 림프절 조직검사를 시행하였고, 반응성 비대를 보여 최종적으로 호산구 위창자염으로 진단하였다.
양혜경,강보라미,이승환,김헌성,윤건호,차봉연,조재형 대한당뇨병학회 2015 Diabetes and Metabolism Journal Vol.39 No.4
Background: This study aimed to evaluate the effect of sitagliptin, an oral dipeptidyl peptidase-4 inhibitor, on insulin secretion and glucagon suppression in Korean subjects with type 2 diabetes mellitus. Methods: Twenty-four subjects underwent a 75-g oral glucose tolerance test (OGTT) before and after 6 months of sitagliptin treatment. Sitagliptin, insulin, and sulfonylurea were withdrawn for 3 days before OGTT to eliminate any acute effects on β-cell insulin or α-cell glucagon secretion. Venous samples were drawn five times during each OGTT to measure plasma glucose, insulin, and glucagon. Indices on insulin secretion and resistance were calculated. Results: Early phase insulin secretion, measured by the insulinogenic index significantly increased after 6 months of sitagliptin treatment, especially in the higher baseline body mass index group and higher baseline glycosylated hemoglobin (HbA1c) group. There were no significant differences in the insulin resistance indices before and after sitagliptin treatment. Although no significant differences were observed in the absolute levels of glucagon and the glucagon-to-insulin ratio, there was a significant reduction in the percentile change of glucagon-to-insulin ratio at 30- and 120-minute during the OGTT. Conclusion: Although the HbA1c level did not decrease significantly after 6 months of sitagliptin treatment, an increase in insulin secretion and reduction in early phase postprandial plasma glucagon-to-insulin ratio excursion was confirmed in Korean subjects with type 2 diabetes.
Cholestyramine Use for Rapid Reversion to Euthyroid States in Patients with Thyrotoxicosis
하정훈,조관훈,강보라미,김민희,임동준 대한내분비학회 2016 Endocrinology and metabolism Vol.31 No.3
Cholestyramine (CS) is an ion exchange resin, which binds to iodothyronines and would lower serum thyroid hormone level. Theuse of CS added to conventional antithyroid drugs to control thyrotoxicosis has been applied since 1980’s, and several studies indicatethat using CS in combination with methimazole (MZ) produces a more rapid decline in serum thyroid hormones than withonly MZ treatment. Our recent retrospective review of five patients taking high dose MZ and CS, compared to age-, gender-, initialfree thyroxine (T4) level-, and MZ dose-matched 12 patients with MZ use only, showed more rapid decline of both free T4and triiodothyronine levels without more adverse events. CS could be safely applicable short-term adjunctive therapy when firstlineantithyroid medications are not enough to adequately control severe thyrotoxicosis or side effects of antithyroid drug wouldbe of great concern.
A Case of Spontaneous Bacterial Peritonitis with Bacteremia Caused by Shewanella algae
김보경,조성연,강보라미,김일규,변지현,박철민,최수미 대한감염학회 2014 Infection and Chemotherapy Vol.46 No.4
Human infection caused by Shewanella algae is rare, which usually occurred after direct contact with seawater or ingestion ofraw seafood in the immunocompromised host. There have been anecdotal reports about Shewanella infections in human, buttheir pathogenic role and microbiologic data are limited. Here, we report a fatal case of spontaneous bacterial peritonitis withbacteremia due to S. algae in a 57-year-old male with liver cirrhosis who had no history of exposure to seawater or raw seafood. Polymicrobial infection with Streptococcus mitis and Escherichia coli was combined and the patient died in spite of earlyappropriate antimicrobial therapy and early goal-directed therapy for sepsis.
S-422 Protective effect of exenatide against the development of diabetes in prediabetes subj ects
김신승,양여리,이준엽,강보라미,양혜경,이은영,이승환,윤건호,차봉연,조재형 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Various researches have been conducted to delay or prevent the development of diabetes in prediabetes subjects. In this study, we aimed to investigate the effect of GLP-1 agonist on prediabetes to evolve to overt diabetes. In this retrospective cohort study, we selected the prediabetes subjects who received the exenatide therapy more than 3 months between 2011 and 2013. Twofold numbers of prediabetes subjects who visited the outpatient clinic around the same time and received only the life style modification education were selected as a control group. The age, sex, BMI, HbA1c and FPG were matched with exenatide group. In this period, a total of 20 prediabetes subjects (3 men and 17 women) received exenatide therapy. Baseline mean age, BMI, HbA1c, and FPG were 54.8±9.2 years, 27.7±3.5 kg/m2, 5.8±0.4 % and 109.6±12.5 mg/dL, respectively. During the mean follow-up period of 39.3±1.0 months, only 2 new cases (10%) of diabetes were identified in exenatide group compared with 13 new cases (32.5%) in control group. An analysis using the Cox proportional hazards model showed that the risk of developing diabetes increased with higher HbA1c (≥6.1%) compared with lower HbA1c (<6.1%); the relative risks (RR) of diabetes were 6.9 times greater. Due to the lack of the case number, we could not show the statistical significance. But the Exenatide showed the possibility of risk reduction (RR: 0.33, 0.95% confidence interval (CI): 0.068 to 1.597, p=0.168).
박윤경,정희찬,김신영,김민영,조관훈,김세영,강보라미,우기현,최현주,위성헌 대한감염학회 2014 Infection and Chemotherapy Vol.46 No.3
Spontaneous pneumothorax occurs in up to 35% of patients with Pneumocystis jirovecii pneumonia. However, spontaneouspneumomediastinum and pneumopericardium are uncommon complications in patients infected with human immunodeficiencyvirus, with no reported incidence rates, even among patients with acquired immunodeficiency syndrome (AIDS) andP. jirovecii pneumonia. We report a case of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax withrespiratory failure during treatment of P. jirovecii pneumonia in a patient with AIDS; the P. jirovecii infection was confirmed byperforming methenamine silver staining of bronchoalveolar lavage specimens. This case suggests that spontaneous pneumomediastinumand pneumopericardium should be considered in patients with AIDS and P. jirovecii pneumonia.
Asymptomatic Myxoma Originating from the Right Ventricular Outflow Tract
김동휘,이정은,인현지,정민영,김문성,이준섭,이종훈,강보라미,정해억,윤호중 한국심초음파학회 2013 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.21 No.4
Asymptomatic right ventricular outflow tract (RVOT) myxoma is quite rare. We report an unusual case of asymptomatic myxoma arising from the RVOT which was successfully surgically removed.
헬리코박터 관련 소화성궤양 환자에서 위산펌프길항제 사용이 요소호기검사 결과에 미치는 영향
옥주현 ( Ju Hyun Oak ),정우철 ( Woo Chul Chung ),정성훈 ( Sung Hoon Jung ),최강현 ( Kang Hyun Choi ),김은정 ( Eun Jung Kim ),강봉구 ( Bong Koo Kang ),강보라미 ( Bo Ra Mi Kang ),공시은 ( Si Eun Kong ),백창렬 ( Chang Nyol Paik ),이 대한소화기학회 2011 대한소화기학회지 Vol.57 No.1
Background/Aims: Revaprazan (Revanex(R)) is a novel proton pump inhibitor (PPI) that has a somewhat different effect on proton pump compared with the other PPI`s, also (called as `acid pump antagonist`). We aimed to examine the false negative rate of (13)C-urea breath test (UBT) in the patients with Helicobacter pylori (H. pylori) associated peptic ulcer disease who were treated with revaprazan and evaluate the anti-urease activity of revaprazan. Methods: Total 55 patients were enrolled in this study. They received EGD examination between January 2009 and December 2009 and diagnosed histologically as H. pylori associated peptic ulcer disease. All patients took revaprazan only. Three patients were excluded because of underlying chronic disease and inappropriate breath sampling. The remaining 52 patients had UBT at 0, 2 and 4 weeks of revaprazan use. After 2 weeks of the cessation of revaprazan, they had the fourth UBT. Results: At 2 and 4 weeks, the false negative rates of UBT were 5.8% and 23.1%, respectively (p=0.05). After 2 weeks of the cessation, the cases of the false negative result were five. Four out of five patients had prolonged negative results on two or three successive tests, and baseline (13)C difference value did not predict the false negative results. Conclusions: False negative results of UBT were common and increased with prolonged use of acid pump antagonist. As PPI, it had also anti-urease activity and most patients (47/52, 90.4%) reverted to positive results by 2 weeks after the cessation of taking the medication. (Korean J Gastroenterol 2011;57:8-13)