당뇨병성 신경근병 ( Diabetic Radiculopathy ) 1 예

김기수(Ghi Su Kim),한명희(Myung Hee Han),정민화(Min Hwa Chung),김문재(Moon Jae Kim),신용운(Yong Woon Shin),정원재(Won Jae Chung),이현철(Hyun Chul Lee),선우일남(In Nam Sunwoo) 대한내과학회 1989 대한내과학회지 Vol.36 No.6

N/A Diabetic radiculopathy is not an uncommon complication of diabetes mellitus but it has been rarely reported until recently. It usually occurs in middle-aged or elderly patients with adult-onset diabetes and is characterized by pain and sensory change in the distribution area of several dermatomes. Diagnosis is easily made with appropriate clinical assessment and needle electromyography findings which include widespread fibrillations and positive sharp waves in the paraspinal muscles. Prognosis is excellent with recovery usually occurring within several months. We report a case of diabetic radiculopathy in a 31- year old insulin dependent diabetic patient who had suffered from colicky epigastric and right flank pain for over 9 months.

항경련제 골연화증 ( Anticonvulsant Osteomalacia ) 1 예

김기수(Ghi Su Kim) 대한내과학회 1989 대한내과학회지 Vol.36 No.4

N/A Although anticonvulsant osteomalacia is an established entity, theories as to its cause are not confirmed. Current evidence indicates that drug induced alterations in the hepatic metabolism of vitamin D play an important role in the pathogenesis of this disorder. Anticonvulsants also exert direct inhibitory effects on mineral and bone metabolism, independent of their effects on viamin D metabolism. A 24-year-old white woman, who had been taking anticonvulsant drugs for 12 years, presented with severe osteopenia and multiple fractures of the thoracic vertebrae without a significant trauma. Osteomalacia was confirmed by an undecalcified section of iliac crest biopsy, Since other causes of osteomalacia were ruled out, anticonvulsants were the most likely cause in this patient.

간장 ( 肝臟 ) , 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 이자 ( 膵臟 ) 외분비 기능에 대한 갑상선 홀몬의 작용

김경환(Kyung Hwan Kim),김기수(Ghi Su Kim),이민구(Min Goo Lee) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3

N/A Exocrine pancreas synthesizes and secretes approximately 20 exportable proteins, most of which are digestive enzymes. The exocrine functions of pancreas are regulated by cholinergic nerve and a number of gastrointestinal kormones, notably secretin and CCK. Recently thyroxine and corticosteroids have also been suggested to act on exocrine pancreas, however, the results are controversia1 and their precise mode of action has not been established. Present study, therefore, was aimed to clarify the role of thyroid hormone and its interaction with corticosteroids, on exocrine pancreatic function in the hyper- and hypothyroid rats induced by thyroxine and PTU with or without adrenalectomy. Male Sprague-Dawley rats, weighing ca. 200 g normal and adrenalectomized, were treated either with L-thyroxine (T4; 0.1 mg/kg/day s.c.) or n-propylthiouracil (PTU;0.01% in drinking water) for 2 weeks to induce hyper- or hypothyroidism. At the end of 2 weeks, the rats were anesthetized (urethane 1.25 g/kg, s.c.) and the pure pancreatic juice was collected after ligation of proximal common bile duct in basal condition and during stimulation by secretin with or without CCK. The secretin-CCK stimulated pancratic enzyme proteins were fractionated by HPLC using TSK phenyl 5PW hydro- phobic interaction column. 1) The increments of body weight during 2 weeks in normal and adrenalectomized rats were 72.5 +- 4.7 g and 38.8 +- 6.0 g, respectively, and the change of thyroid status to hypo- or hyperfunction caused further decrease of the weight gain. 2) The pancreas weight (g/100 g B.W.) was decreased in hypothyroid and increased in hyperthyroid rats regardless of adrenaletomy. 3) The pancreatic juice flow was decreased in hypothyroid rats and increased in hyperthyroid rats which is more prominent in basal secretion than in stimulated secretion. 4) Total protein content in pancreatic juice was decreased in hypothyroid and increased in hyperthyroid rats which is not related to adrenal status but adrenalectomy itself caused increase of protein secretion. 5) The HPLC chromatogram revealed 9 isozyme fractions consisting of 2 lipases, 2 trypsinogens, 2 procarboxypeptidases, proelastase, chymotrypsinogen and amylase. Chymotrypsinogen was the highest fraction as a single enzyme but two trypsinogen isozyme fractions occupied the highest proportion among the total enzyme protein. 6) The proportions of pancreatic enzyme fractions are modified by the changes of thyroid status; those are, in hypothyroid rats, the lipase fractions were decreased and proelastase was increased, however, in hyperthy#roid rats, proelastase fraction was decreased. Adrenalectomy itself did not cause any significant influence on the ratio of all enzyme fractions. These results suggest that thyroid hormone enhances exocrine function of pancreas directly independent of adrenocortical hormones, and the change of thyroid status induces anticoordinate synthesis or non-parallel secretion.

저에너지 손상에 의한 고관절 골절 환자에서 골밀도와 골대사 지표의 분석

김신윤(Shin Yoon Kim),정호성(Ho Sung Jung),박일형(Il Hyung Park),박병철(Byung Chul Park),박의균(Eui Kyun Park),김기수(Ghi Su Kim),하용찬(Yong Chan Ha) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.3

목적: 골다공성 골절군과 정상 대조군을 남, 여 성별에 따라 분류하고, 각각의 골밀도와 골대사 지표를 비교, 분석하여 골밀도의 감소와 골교체의 이상이 골다공성 골절의 한 원인으로 작용하는지를 분석하였다. 대상 및 방법: 1999년 11월부터 2003년 8월 까지 교통사고 및 추락 등 고에너지 손상이 아닌 낙상 등 저 에너지 손상으로 인한 고관절부 골절로 본원에서 치료한 76명과 대조군 83명을 대상으로 하였다. 골절군은 남자가 22예, 여자가 54예이었고 평균나이는 남자가 67.2 (51-79)세이었고, 여자가 71.1 (55-87)세이었다. 대조군은 남자가 22예, 여자가 61예이었고, 평균나이는 남자가 67.9 (57-85)세, 여자가 70.1 (60-80)세이었다. 골밀도는 이중에너지 방사선 흡수계측기를 이용하여 측정하였고, 골대사 지표로는, 혈청 골 특이성 알칼리 인산분해 효소와 혈청 osteocalcin을 골 형성지표로 측정하였고, 골 흡수 지표로 요 deoxypyridinoline을 측정하였다. 결과: 혈청 골 특이성 알칼리 인산분해 효소의 평균값은 남녀 모두 골절군에서 통계학적으로 대조군보다 유의하게 낮았다(p<0.05). 혈청 osteocalcin의 평균값도 남녀 모두 골절군에서 통계학적으로 대조군보다 유의하게 낮았다(p<0.05). 요디옥시피리디놀린의 평균값은 남녀 모두 골절군과 대조군 사이에 의미있는 차이는 없었다. DEXA를 이용하여 측정한T-score의 평균값은 남녀 모두 골절군에서 유의하게 낮았다(p<0.001). 결론: 골다공성 골절군에서 남녀 모두 대조군보다 골밀도 및 골형성이 감소되는 것으로 나타나, 골밀도의 감소와 골형성의 저하가 골다공성 골절의 원인으로 작용하는 것으로 분석되었다. Purpose: This study was conducted to compare bone mineral density (BMD) and biochemical markers of bone metabolism of an osteoporotic hip fracture group with those of a control group. Materials and Methods: The fracture group included 76 patients with hip fractures who were injured by low energy trauma from November, 1999 to August, 2003. The control group consisted of 83 patients recruited over the same period. There were 22 men and 54 women in the fracture group, with an average age of 67.2 years for men and 71.1 years for women. In the control group, there were 22 men and 61 women, of average age 67.9 years for men and 70.1 years for women. There were no siginificant differences in age, height, weight, or body mass index. We analyzed BMD by a dual energy X-ray absorptiometry (DEXA). Bone specific alkaline phosphatase (B-ALP) and osteocalcin were used as markers of bone formation and urine-deoxypyridinoline (DPD) as a maker of bone resorption. Results: B-ALP showed a significant decrease in the fracture group (p<0.05). Also, average serum osteocalcin showed a significant decrease in the fracture group (p<0.05). There was no significant difference in urine-DPD between the two groups. The mean values of BMD in men and women were significantly decreased in the fracture group. Conclusion: The results of this study suggest that a decreased BMD contributes to hip fractures in elderly people and that B-ALP and serum osteocalcin rather than urine-DPD are reliable biochemical markers of bone metabolism in osteoporotic hip fractures.

인슐린 비의존형 당뇨병환자에서 혈관합병증과 Lipoprotein ( a ) 의 관계

김선희(Seon Hee Kim),채희복(Hee Book Chai),박중열(Joong Yeol Park),민원기(Won Ki Min),김우건(Woo Kun Kim),김기수(Ghi Su Kim),이기업(Ki Up Lee) 대한내과학회 1997 대한내과학회지 Vol.52 No.3

N/A Objectives: High serum Lp(a) concentration is associated with a high risk of coronary artery disease(CAD). This study was initiated to determine whether increased Lp(a) levels are associated with diabetic vascular complications in Korean patients with NIDDM. Methods: A total of 183 NDDM patients were studied cross-sectionally for the presence of various vascular complications. Lp(a) levels were measured by 1-step sandwich ELISA method. Results: The patients with overt proteinuria had higher Lp(a) levels than the patients with mormo- albuminuria or microalbuminuria(26.8mg/dl vs 13.8 mg/dl and 17.3mg/dl, p<0.05), The patients with proliferative retinopathy and/or those treated by photocoagulation had higher Lp(a) levels than those without retinopathy or those with background retinopathy(34.1mg/dl vs 13.3mg/dl and 16,9mg/dl, p<0.05), The Lp(a) levels were also higher in the patients with CAD than those without CAD(30.9mg/ dl vs 16.3mg/dl, p<0.05). Multiple logistic regression analysis revealed that high Lp(a) levels were independantly associated with CAD and severe diabetic retinopath3. Conclusion: High Lp(a) levels are associated with CAD and proliferative retinopathy in Korean patients with NIDDM.

혈청 C - peptide 치로 정의한 한국인 인슐린 의존형 당뇨병 환자의 임상상

김상욱(Sang Wook Kim),이기업(Ki Up Lee),정상식(Sang Sik Cheong),김형호(Hyeong Ho Kim),박중열(Joong Yeol Park),김기수(Ghi Su Kim),이문호(Mun Ho Lee) 대한내과학회 1993 대한내과학회지 Vol.45 No.6

N/A Background: Diabetes mellitus is one of the major health problems in Korea. It has been suggested that there are quite many atypical IDDM patients who initially manifest as NIDDM, but require insulin eventually. However, little is known about the clinical characteristics of this type of diabetics in Korea. This study was undertaken to find out how many current IDDM patients bad a history of noninsulin requiring phase. Methods: We obtained medical histories retrospectively from 2300 patients who visited Asan Medical Center from June 1989 to July 1992. Fifty nine patients were classified as IDDM because their fasting plasma C-peptide levels were below 0. 13fmol/L (0.4ng/ml). The patients were classified further into the two groups: group A who required isulin within 1year after diagnosis or presented as debut DKA, and group B who had nonisulin requiring phase at least for 1year after the diagnosis. Results: Twenty six patients (44%) were classified as group A, and 27patients (46%) as group B. Median age of onset was 26years in group A, (range; 10-50) and 45 (range; 23-73) in group B. As a whole, 24patients (41percent) were diagnosed as diabetes over the age of 40. Two groups had similiar values in body mass index. History of DKA was found in 58percent in group A and 7percent in group B. All patients of group A were using insulin at the time of the study, while only 56percent of group B were using insulin. Conclusion: Our study showed: first, forty percent of IDDM patients developed their diabetes at the age over 40: second, about half of the patients had a non-insulin- requiring phase at least for one year, The lack of DKA, old age of onset, and the initial non-insulin-requiring phase suggest that these patients are different from the typical IDDM. This subclass of IDDM in Korea may be classified as slowly progressive IDDM.

인슐린 비의존형 당뇨병환자에서 중식성 망막증 발생에 관한 종적연구

조구영(Goo Yeong Cho),김상욱(Sang Wook Kim),이미화(Mee Wha Lee),박중열(Joong Yeol Park),제수정(Soo Jung Je),이기업(Ki Up Lee),김기수(Ghi Su Kim) 대한내과학회 1994 대한내과학회지 Vol.47 No.4

N/A Background: Proliferative diabetic retinopathy (PDR), a late stage of diabetic retinopathy, is the com- monest cause of acquired blindness in adults. Despite many previous studies, the risk factors for the development of PDR in Korean NIDDM patients have not been precisely defined yet. The aims of the present study were to evaluate the incidence and the risk factors of PDR. Method: From April to June 1993, we retrospectively studied 243 NIDDM outpatients (duration of diabetes 7.9±7.1, age 54.5±10.8, male 110 and fema1e 133) who had undertaken fundoscopic examination for diabetic retinopathy before April 1991. At the time of the examination, 70 patients had nonproliferative diabetic retinopathy (NPDR). Of those, 12 patients progressed to PDR and 58 patients did not. Clinical characteristics and laboratory findings of progressed group were compared with non-progressed group. Results: Of the 162 patients who were free of diabetic retinopathy at the initial examination, 18 patients progressed to diabetic retinopathy; the incidence rate of diabetic retinopathy was 34.9/1,000 person-yr. Of these, 1 patients had PDR (1.9/1,000 person-yr). After 2.6 years of mean follow-up, 12 out of 70 patients with initial NPDR progressed to PDR. The incidence rate of PDR in the patients with NPDR was 63.2/1,000 person-yr. Microalbuminuria, more severe weight loss, lower level of C-peptide and insulin therapy were associated with an increased 2.6-year risk of developing PDR. However, sex, smoking, use of antihypertensive drugs or aspirin, age, duration of diabetes and the mean fasting serum glucose, hemoglobin Al, cholesterol, systolic or diastolic blood pressure levels during the follow-up period were not associated with the progression to PDR. Forward stepwise multiple logistic regression analysis revealed that initial microalbuminuria and delta BMI are significant independent predictor for the progression to PDR. Conclusion: Microalbuminuria can be used as a predictor for progression to PDR. Lower level of C-peptide, more severe weight loss and current insulin use may be also the risk factors for progression to PDR in Korean NIDDM patients with nonproliferative retinopathy. However, long-term prospective study is warranted to answer the question more properly.

당뇨병이 없는 정상성인에서 미세단백뇨의 임상적 의의

채희복(Hee Bok Chae),김철희(Chul Hee Kim),이기만(Ki Man Lee),박중열(Joong Yeol Park),홍성관(Sung Kwan Hong),김기수(Ghi Su Kim),이기업(Ki Up Lee) 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectives: It has been reported that microalbuminuria is associated with increased cardiovascular mortality in both diabetic and non-diabetic subjects. This study was initiated to see whether microalbuminuria is associated with cardiovascular risk factor in Korean non-diabetic subjects. Methods: We examined various correlates of microalbuminuria in 221 non-diabetic subjects aged 50-59 years who visited health promotion center of Asan medical center. Results: 1) Microalbuminuria was detected in 7%(15/211) of Korean non-diabetic subjects. 2) The subjects with microalbuminuria had higher BMI(25.0 vs. 23.8kg/m²), higher systolic and diastolic blood pressure(143/87 vs, 124/95mmHg), higher serum cholesterol(220 vs. 201mg/dL), higher triglyceride(151 vs. 99mg/dL), higher fasting insulin levels(9.8 vs. 6.1 μU/ml) than the subjects with normoalbuminuria. 3) Multiple logistic regression analysis revealed that microalbuminuria was independently related to age, blood pressure, and fasting serum insulin levels. Conclusion: We found that significant proportion of Korean non-diabetic subjects had microalbuminuria. Microalbuminuria was associated with various cardiovascular risk factors including higher fasting serum insulin level. These findings suggest that microalbuminuria may form part of the insulin resistance syndrome, so called Syndrome X.

증례 : 장티푸스에 합병된 급성횡단성척수염

고윤웅 ( Yun Woong Ko ),채응석 ( Eung Suk Chai ),한지숙 ( Jee Sook Hahn ),김기수 ( Ghi Su Kim ) 대한내과학회 1977 대한내과학회지 Vol.20 No.6

인슐린 비의존형 당뇨병환자에서의 사구체 여과율

황일란(Il Ran Hwang),이기업(Ki Up Lee),양원석(Won Seok Yang),문대혁(Dae Hyuk Mun),김기수(Ghi Su Kim),김순배(Sun Bae Kim),박수길(Su Kil Park),박정식(Jung Sik Park) 대한내과학회 1992 대한내과학회지 Vol.43 No.6

N/A Background: Glomerular hyperfiltration is found in 30 to 40% of patients with IDDM at the onset of disease. Several lines of evidence suggest that this may be responsible for the progression of diabetic nephropathy. Whether glomerular hyperfiltration is a frequent finding in patients with NIDDM is controversial. Methods: To define the prevalence of glomerular hyperfiltration in patients with NIDDM without clinical proteinuria, we measured GFR in 79 patients with NIDDM and 33 healthy subjects using 51Cr-EDTA clearance. Urine albumin level was determined by radioimmunoassay. Results: GFR in 58 normoalbuminuria group and 21 microalbuminuria group were 129±24 and 127±34ml/ min/1. 73 m' respective1y, which were significantly higher than that in control group (113±20). Hyperfiltration, as defined by a GFR of more than 140 ml/min/1.73 m, was found in 32% (25/79) of NIDDM without clinical diabetic nephropathy. There was no difference in GFR or the prevalence of hyperfiltration between the normoalbuminuria (29%, 17/58) and the microalbuminuria (38%, 8/21) group. Fasting plasma glucose level in patients with hyperfiltration was significantly higher than that in those without hyperfiltration. Conclusion: Glomerular hyperfiltration is frequently found in Korean NIDDM patients without clinical diabetic nephropathy. This finding is similar to the previous reports in Pima Indians and Black Americans