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고장현,신영구,이미영,정춘희,남수민,성중경,정필문,노진규,신장열 대한당뇨병학회 2008 Diabetes and Metabolism Journal Vol.32 No.3
Background: Postmenopausal status is associated with a 60% increased risk for metabolic syndrome. It is thought to be associated with decreased estrogens and increased abdominal obesity in postmenopausal women with metabolic syndrome. The purpose of this study was to investigate the association between metabolic syndrome components and menopausal status.Methods: A total of 1,926 women were studied and divided into three groups according to their menstrual stage(premenopausal, perimenopausal or postmenopausal). The presence of metabolic syndrome was assessed using the National Cholesterol Education Program's(NCEP) Adult Treatment Panel Ⅲ criteria. Results: The prevalence of metabolic syndrome was 7.1% in premenopause, 9.8% in perimenopause, and 24.2% in postmenopause. The strong correlation was noted between the metabolic syndrome score and waist circumference in postmenopause(r = 0.56, P < 0.01) and perimenopause(r = 0.60, P < 0.01). Along the menopausal transition, the risk of metabolic syndrome increased with high triglyceride after the age-adjusted(odds ratio(OR) 1.517 [95% confidence interval(CI) 1.014~2.269] in perimenopausal women and OR 1.573 [95% CI 1.025~2.414] in postmenopausal women). In addition, the prevalence of metabolic syndrome increased in accordance with elevated alanine aminotransferase(ALT) and gamma-glutamyl transpeptidase(GGT) levels. Conclusion: Triglyceride and waist circumference were important metabolic syndrome components, though ALT and GGT may also be related for predicting metabolic syndrome during the transition to menopause. (KOREAN DIABETES J 32:243-251, 2008)
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고장현,고상백,이미영,정필문,김보환,신장열,신영구,류소연,이태용,박종구,정춘희 대한의학회 2010 Journal of Korean medical science Vol.25 No.5
The Korean Society for the Study of Obesity (KSSO) has defined the waist circumference cutoff value of central obesity as 90 cm for men and 85 cm for women. The purpose of this investigation was to determine the corresponding waist circumference values. A total of 3,508 persons in the Korean Rural Genomic Cohort Study were enrolled in this survey. Receiver operating characteristic (ROC) curve analysis was used to find appropriate waist circumference cutoff values in relation to insulin resistance determined by homeostasis model assessment for insulin resistance (HOMA-IR), body mass index (BMI), and components of metabolic syndrome. The optimal waist circumference cutoff values were 87 cm for men and 83 cm for women by ROC analysis to HOMA-IR and 86 cm for men and 83 cm for women by ROC analysis to value with more than two components of metaobolic syndrome. By using a BMI ≥25 kg/m2, 86 cm for men and 82 cm for women were optimal waist circumference cutoff values. In this study, we suggest that the most reasonable waist circumference cutoff values are 86-87 cm for men and 82-83 cm for women.
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성중경,고장현,이미영,김보환,남수민,김재현,유진희,김소희,홍순원,이은영,최란,정춘희 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.3
Purpose: The vascular endothelial growth factor (VEGF) expression of podocyte is one of the well-known major factors in development of diabetic nephropathy. In this study, we investigated the effects of aldose reductase inhibitor, fidarestat on diabetic nephropathy, and renal VEGF expression in a type 1 diabetic rat model. Materials and Methods: Twenty four Sprague-Dawley male rats which were performed intraperitoneal injection of streptozotocin and normal six rats were divided into four groups including a normal control group, untreated diabetic control group, aldose reductase (AR) inhibitor (fidarestat, 16 mg ˙ kg-1 ˙ day-1) treated diabetic group, and angiotensin receptor blocker (losartan, 20 mg ˙ kg-1 ˙ day-1)treated diabetic group. We checked body weights and blood glucose levels monthly and measured urine albumin-creatinine ratio (ACR) at 8 and 32 weeks. We extracted the kidney to examine the renal morphology and VEGF expressions. Results: The ACR decreased in fidarestat and losartan treated diabetic rat groups than in untreated diabetic group (24.79 ± 11.12, 16.11 ± 9.95, and 84.85 ± 91.19, p < 0.05). The renal VEGF messenger RNA (mRNA) and protein expression were significantly decreased in the fidarestat and losartan treated diabetic rat groups than in the diabetic control group. Conclusion: We suggested that aldose reductase inhibitor may have preventive effect on diabetic nephropathy by reducing renal VEGF overexpression.
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이미영,고장현,남수민,정필문,성중경,김송이,신장열,신영구,정춘희 연세대학교의과대학 2008 Yonsei medical journal Vol.49 No.6
Purpose: The short insulin tolerance test is a simple and reliable method of estimating insulin sensitivity. This study was designed to compare the insulin sensitizing effects of thiazolidinediones (TZDs) on the degree of insulin resistance, determined by a short insulin tolerance test (Kitt) in type 2 diabetic patients. Patients and Methods: Eighty-three subjects (mean age=57.87±10.78) with type 2 diabetes mellitus were enrolled and received daily one dose of rosiglitazone (4mg) or pioglitazone (15mg). The mean follow-up duration was 25.39±9.66 months. We assessed insulin sensitivity using HOMA-IR and the short insulin tolerance test before and after TZDs treatment. Results: When we compared patients’ characteristics before and after TZDs treatment, the mean fasting glucose level was significantly decreased (183.27±55.04 to 137.35±36.42mg/dL, p<0.001) and the mean HbA1C level was significantly decreased (9.24±1.96 to 8.11±1.39%, p<0.001). Also, Kitt values were significantly increased (2.03±1.14 to 2.67±0.97%/min, p=0.003), whereas HOMA-IR was significantly decreased (2.98±0.68 to 1.04±0.24, p<0.05). When classifying insulin resistance by Kitt values, insulin resistant subjects’ values were increased (<2.5 %/min; 1.51±0.53%/min to 2.63±0.88, p<0.001), whereas the values decreased in insulin sensitive subjects (≥2.5%/min; 3.50± 0.75%/min to 2.75±1.12%/min, p=0.002). Conclusion: The glucose lowering effects of TZDs by improving insulin resistance could be determined by using Kitt. However, Kitt may be a beneficial tool to determine TZDs’ effects only when patients’ Kitt values are less than 2.5%/min.
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정필문,이미영,고장현,신장열,신영구,조미연,정춘희 대한내분비학회 2007 Endocrinology and metabolism Vol.22 No.2
It has been suggested that autoimmune thyroid disease could be combined with other autoimmune diseases such as idiopathic thrombocytopenic purpura, sarcoidosis and inflammatory bowel disease. In inflammatory bowel diseases, ulcerative colitis is more strongly associated with autoimmune thyroid diseases than Crohn's disease. However, there is no clear explanation for the concurrent existence of the two diseases, although immunological mechanisms seem to play a significant role. We report here on a case of a 48-years-old woman who had ulcerative colitis with Graves' disease. Her chief complaint was abdominal pain and mucinous diarrhea. She was diagnosed with Graves' disease 1 year ago and had been taking medication. Colonoscopic biopsy was performed and she was diagnosed with ulcerative colitis. We suggest that a clinician should be aware of the coexistence of Graves' disease and ulcerative colitis in some patients, which is obviously very important for the patient's outcome. (J Kor Endocrine Soc 22:149~152, 2007) 본 저자는 그레이브스병으로 약물치료 중인 환자에서 복통과 점액성 설사의 증상을 보여 검사를 시행한 결과 궤양성 대장염이 진단된 사례를 경험하였기에 이를 보고하는 바이다.
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최윤정,박용래,고장현 연세대학교의과대학 2008 Yonsei medical journal Vol.49 No.5
Purpose: To assess the incidence of thyroid malignancy in an adult population screened by high-resolution ultrasonography at a medical screening center and to compare the clinical and pathological features of screen-detected thyroid carcinomas to symptomatic overt thyroid carcinomas. Materials and Methods: We calculated the prevalence of screen-detected thyroid cancer at a medical screening center using high- resolution ultrasonography and fine needle aspiration. We then compared the clinical and pathological features of screen- detected thyroid cancers (n=46) to clinical symptomatic thyroid cancers (n=157). We evaluated age, gender, size, perithyroidal extension, lymphovascular extension, stage, histological lymph node metastasis, and the type of cancer. We also compared the above findings of micropapillary carcinomas to papillary thyroid carcinomas that were larger than 1cm in diameter. Results: Screen-detected thyroid nodule patients were 2,747 (37%) of 7,491 patients. Nodules selected for fine needle aspiration were 658 and cytology confirmed malignancy were 79 (12%) nodules. When screen-detected thyroid cancers (n=46) were compared to symptomatic overt thyroid cancers (n=157), only statistically significant factor was size (p=0.002). Papillary thyroid carcinomas that were larger than 1 cm had more frequent capsular invasion (p=0.000) and a higher stage (p=0.027), and a higher prevalence of lymph node metastases (p=0.002). Conclusion: Screen-detected thyroid cancers should be managed as same as symptomatic thyroid cancers in respect to size, and an assessment should strictly be based on the ultrasound features and fine needle aspiration biopsy findings.
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일시적인 갑상선중독증을 동반한 소아의 급성 갑상선주위염 1예
남수민,이미영,고장현,성기준,정춘희 대한내분비학회 2006 Endocrinology and metabolism Vol.21 No.2
Acute thyroiditis is a rare disease because of the sufficient supply of blood vessels and lymphatics in thyroid tissue, the high concentration of iodide in the thyroid tissue and the nearly completely isolated structure of the thyroid gland from the surrounding tissue via its capsule. The most common route of infection is from a pyriform sinus fistula and then the inflammation spreads from the sinus to the perithyroidal space. Computed tomography (CT) and magnetic resonance imaging (MRI) can show a low echogenic mass encircling thyroid gland and swelling of the perithyroidal tissue in acute suppurative thyroiditis. We experienced a case of acute perithyroiditis with thyrotoxicosis that developed in a 13-year old boy and he was diagnosed by the CT findings. The patient had complained of a low graded fever and neck swelling. The laboratory diagnosis and clinical course was like that of subacute thyroiditis, but the CT finding showed a show low echogenic mass encircling the thyroid glands and swelling of the perithyroidal tissue. Therefore, we diagnosed this patient with acute perithyroiditis. After treatment with antibiotics, he displayed clinical improvement and was discharged. (J Kor Soc Endocrinol 21:142~145, 2006) 본 환자의 증례는 영상 진단상 갑상선중독증을 동반한 급성 갑상선주위염으로 진단하였으며 이에 문헌고찰과 함께 보고하는 바이다.
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