당뇨병성 경화부종 - 임상 - 병리조직학적 연구 및 문헌고찰 -

황호근(Ho Geun Hwang),이승하(Seoung Ha Lee),형근영(Keun Young Hyoung),신봉주(Bong Joo Shin),김경년(Kyoung Nyeon Kim),조정구(Chung Gu Cho),김주섭(Ju Seob Kim),차승훈(Seung Hoon Cha),박석돈(Seok Don Park) 대한내과학회 1996 대한내과학회지 Vol.51 No.4

N/A Objectives: We studied clinical feature, underlying disease and histo-pathologic finding of scleredema diabeticorum that was observed as non-pitting indurated edematous skin of the nape, occiput in non-insulin dependent diabetes mellitus. Methods: We performed clinico-histopathologic study in 5 cases of scleredema diabeticorum which were diagnosed at our hospital and reviewed 6 cases in Korean literatures. Results: 1) The male to female ratio was 4:1, The overweight or obese middle-aged (mean:54.6) males were prone to develop these cutaneous changes. There was no relationship between the development of diabetic scleredema and the duration, the severity of diabetes. Hypertension and hyperlipidemia were frequent associated finding among the patients. 2) The increased level of fasting C-peptide implicated that the ability of insulin secretion was preserved. 3) Non-pitting hardening of the skin on the nape, head and surrounding parts of the body was common skin change in all patients. No evidence of systemic involvements was found. 4) Typical histopathologic findings, consisted of the thickening of dermis, the degeneration of collagen bundles in mid- to deep dermis, and the deposition of acid mucopoleysaccharides, hyaluronic acid, were noted in 4 cases of our study. 5) The therapeutic responses of cutaneous changes were generally poor. Conclusion: These results implies that scleredema diabeticorum is not a rare cutaneous manifestation among the diabetic dermadromes, and special histopathologic stainings with skin tissue sections are necessary for diagnosis. Although the exact mechanisms of this disease are not known, and no effective therapy is available, it needs to be studied exactly that the facts of hyperlipidemia, overweight, hypertension and well-preservation of fasting C-peptide observed in our cases, may be related to syndrome-X.

건 황색종의 가족력과 관상동맥질환을 갖는 이형집합 가족성 고 콜리스테롤혈증 1례

백승훈,형근영,김경년,조정구,이경근 圓光大學校 醫科學硏究所 1997 圓光醫科學 Vol.13 No.1-2

Familial hypercholesterolemia is a common autosomal dominant disorder with serious health consequences such as the coronary heart disease, in western area affecting approximately 1 in 500 persons in the heterozygous form, is caused by a mutation in the gene for the LDL(low density lipoprotein) receptor. A-45-years old male came to the hospital because of tendon xanthomas on both elbows, knees, and ankles. He also has retrosternal chest pain intermittently since 5 years ago. 4 kindreds of the patient have tendon xanthomas according to autosomal dominant inheritance. Serum levels of total cholesterol and triglyceride were 359 ㎎/dL, 103 ㎎/dL respectively. Lipoprotein electrophoresis showed type Ⅱa pattern. Treadmill exercise test revealed angina pectoris. The case of familial hypercholesterolemia who has familial inheritance of tendon xanthoma is rarely reported in Korea. We report this case with a review of the related literature

당뇨병성 망막병증 환자의 망막중심과 모세혈관에서 백혈구 순환속도

김재덕,양연식,조정구,김경년 대한당뇨병학회 1995 Diabetes and Metabolism Journal Vol.19 No.1

50세에 케톤산중 혼수를 첫 증상으로 발생한 제1형 당뇨병 1예

유경훈,백승훈,이재홍,김경년,조규혜,조정구 圓光大學校 醫科學硏究所 1998 圓光醫科學 Vol.14 No.2

Type 1 diabetes(Insulin-dependent) is caused by the selective destruction of the insulin secreting islet cells of the pancreas and is an autoimmune disease that occurs among genetically susceptible individuals most often develops in children and young adults, but sometimes in people over 40 years of age. These individuals may be characterized by autoantibodies to GAD and high-risk HLA DQ alleles, which are unlikely to be prevalent among patients with true type 2 diabetes. There are differences between type 1 patients of over 40 years at diagnosis and adult type 1 diabetic patients with onset at a younger age. There are strong evidence for humoral and cellular autoimmunity in adult type 1 diabetic patients with onset both before and after 40 years of age. The incidence of type 1 diabetes in the age group over 40 year at onset is variable to races and nations. The present study indicates that type 1 diabetes may develop at any age. Thus the life-time risk of developing type 1 is higher than hitherto expected. Adult-onset type 1 diabetes may represent a disease that is biologically distinct from youth-onset type 1, and it would be important to distinguish these two entities. A very large population base would be required to identify sufficent numbers of adult-onset type 1 cases for study of the etiology and pathogenesis of this disease. Diabetic ketoacidosis(DKA) is a common illness among individuals with insulin dependent diabetes mellitus considered largely preventable. The major metabolic derangements of type 1 diabetes are hyperglycemia, excessive ketonemia and ketonuria. Type 1 diabetes is usually believed to present acutely, and it is assumed that metabolic decompensation is sudden. DKA is an acute metabolic complication of diabetes mellitus that can be life threatening. Correct classification of diabetic patients in adulthood at the time of diagnosis is often difficult. The treatment of DKA should be started as soon as its diagnosed, and the goal of the therapy is to increase the rate of glucose utilization by insulin dependent-tissues. This case is type 1 diabetes of 50 year old woman who presented a diabetic ketoacidosis as her first symptom on a late-onset type 1 diabetes.

생쥐 배양 슈반세포에서 streptozotocin의 독성 및 항산화제의 보호효과

조정구,김경년,김경희,박승택 한국노화학회 1998 한국노화학회지 Vol.8 No.3

Bezafibrate 에 의해 유도된 횡문근 융해증 1 예

조정구,신봉주,김경년,김형언,유남진 대한내분비학회 1994 Endocrinology and metabolism Vol.9 No.1

The case is presented a 49-year-old man had several year history with chronic renal failure with hyperlipidemia due to diabetes mellitus. Treatment of hyperlipidemia was started by oral bezafibrate intake 600 mg per day. Several days later, patient noticed muscle weakness and myalgia. The serum CK, LDH, AST levels were remarkably elevated, myoglobulinuria was also noticed The symptoms of the patient were resolved after the drug was discontinued, thus the diagnosis was established as having bezafibrate induced rhabdomyolysis. On the basis of the above description, bezafibrate may induce muscle damage if dose is excess over the renal capacity. Extreme caution is warranted when the patient is placed on bezafibrate and has renal dysfunction. Strict dose adjustment is necessary in taking account of renal function to avoid muscle damage including rhabdomyolysis(J Kor Soc Endocrinol 9:50-53, 1994).

Xanthomonas Maltophilia 에 의한 급성 화농성 갑상선염 1 예

조정구,신봉주,최두환,소재범,유광현,김경년 대한내분비학회 1995 Endocrinology and metabolism Vol.10 No.2

Acute thyroiditis(acute suppurative thyroiditis, bacterial thyroiditis, pyogenic thyroiditis) is an uncommon inflammatory disease, usually bacterial in orign, but may be fungi, parasitic organisms. A case of acute suppurative thyroiditis was reported and review of literature was made. A 51-year-old female noted pain and swelling of her neck. Cardinal physical finding on admission was enlargement of thyroid gland accompanied by tenderness and local heat. Diagnosis of acute suppurative thyroiditis was made by needle aspiration of the thyroid gland. The aspirated material showed inflammatory cells and follicular cells. In culture, Xanthomonas maltophilia was isolated. After antibiotics administration, she was discharged with improvement of tender enlargement of the thyroid gland(J Kor Soc Endocrinol 10: 131-135, 1995).

당뇨병성 케톤산증에 병발한 횡문근융해증 1예

장근영,이명수,최용원,최경숙,김상욱,김기훈,박병현,형근영,김경년,정병화,조정구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

당뇨병성 케톤산증이나 비삼투압성 비케톤성 혼수환자에서 횡문근융해에 의한 급성신부전이 동반될 수 있으며 이러한 기전은 확실히 밝혀져 있지 않다. 저자들은 당뇨병성 케톤산증 환자에서 횡문근융해증 및 근색소뇨증, 급성신부전을 보인 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Since osmotic diuresis, which is provoked by a high renal glucose load, prevents the development of acute tubular necrosis; there have been a few case reports connecting diabetic ketoacidosis with acute renal failure, secondary to rhabdomyolysis. Rhabdomyolysis is a clinical and biochemical syndrome, resulting from skeletal muscle injury with release of muscle contents, specifically myoglobin into the plasma and it has been implicated as a major cause of acute renal failure. Rhabdomyolysis is diagnosed in the presence of myoglobinuria and raised level of serum creatinine phosphokinase (CPK). We report a case of diabetic ketoacidosis which developed acute renal failure secondary to rhabdomyolysis and myoglobinuria with review of the literature. A 67-year-old man suffering from somnolence was admitted to our hospital. He had had coughing, sputum, chills for 7 days prior to the onset of somnolence. He was a type 2 diabetic patient and had been omitting oral hypoglycemic agent for two months. Laboratory data an admission reveled elevated serum levels of glucose (>27 mmol/L), myoglobin (>500 ng/㎗), creatinine phosphokinase (2,156IU/L), lactate dehydrogenase (1,679 IU/L), blood urea nitrogen (12.4 mmol/L) and creatinine (247 mmol/L). Ketone and myoglobin (75 ng/㎗) was defected in urine. Arterial blood gas analysis reveled pH 7.104, PCO₂ 15 mmHg, PO₂ 108.3 mmHg, HCO₃ 4.8 mmol/L, Chest film showed pneumonic consolidation on right lower lung. Treatment with subcutaneous insulin and intravenous administration of electrolyte fluid and the systemic antiobiotics was begun immediately. After initiation of treatment, there was increase in serum creatinine 0(707 mmol/L), blood urea nitrogen (56.7 mmol/L), and anuria w as observed. Despite of care, he died.