Statin 의 치료 효과: 제제에 따라 임상적으로 중요한 차이가 있는가?

김두만 ( Kim Du Man ) 한국지질동맥경화학회 ( 구 한국지질학회 ) 2003 춘계학술대회 Vol.- No.-

혼합형 고지혈증

김두만 ( Kim Du Man ) 한국지질동맥경화학회 ( 구 한국지질학회 ) 2002 韓國脂質學會誌 Vol.12 No.3

지질대사 이상을 치료하는 많은 약제들이 개발되어 현재 임상에서 사용 중이며 이들은 혈청 지질의 여러 가지 구성성분에 다양한 영향을 미치고 HMG CoA reductase inhibitor, fibric acid 유도체, nicotinic acid 등의 몇 가지의 종류로 대별할 수 있다. 약물 치료가 필요한 어떤 지질대사 이상 (고지혈증 또는 이상지혈증) 환자를 치료하기 전에 먼저 환자의 고지혈증의 근본을 정확히 파악할 필요가 있다. 고지혈증의 진단과 구

임신 중 진단된 간의 악성 흑색종 자연파열

김두만 ( Du Man Kim ),유시현 ( Sie Hyun You ),윤주희 ( Joo Hee Yoon ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.9

The incidence of all malignant tumor in pregnancy is 0.07-0.1%. The most frequent tumors in pregnancy are breast cancer, gynecologic tumors (cervical cancer, ovarian cancer), melanoma and lymphomas. Any malignant tumor in pregnancy has a diagnostic and therapeutic problem. Melanoma is 8% of all malignancies in pregnancy. Surgery is a definitive therapy for early-stage disease. Melanoma in pregnancy metastasize early and rapidly. So we have difficulty in making therapeutic plan. Most frequent metastatic lesions are liver and lung. We experienced melanoma of liver in pregnancy. This report represents melanoma in pregnancy with a review of literature.

6대 질환 건강강좌 당뇨병부분 김두만 교수 인터뷰

김두만,Kim, Du-Man 사단법인 한국당뇨협회 2006 당뇨 Vol.200 No.-

새해맞이 인터뷰-강동성심병원 김두만 교수

김두만,Kim, Du-Man 사단법인 한국당뇨협회 2007 당뇨 Vol.206 No.-

국방적 측면에서 본 항공우주공업

김두만,Kim, Du-Man 항공산업연구소 1979 항공산업연구 Vol.1 No.-

정상 임산부에서 fT4와 TSH에 관한 연구

조윤성 ( Yun Sung Jo ),김두만 ( Du Man Kim ),이귀세라 ( Gui Se Ra Lee ),김민정 ( Min Jeong Kim ),김사진 ( Sa Jin Kim ) 대한주산의학회 2009 Perinatology Vol.20 No.4

목적: 연구에서 우리나라의 갑상선 질환이 없는 정상 임산부를 대상으로 TSH (thyroid-stimulating hormone)와 fT4 (free thyroxine)를 측정하여 임신 시기별 변화와 정상범위를 구해보고자 하였다. 방법: 2007년 1월부터 2008년 6월까지 가톨릭대학교 성가병원 산부인과 외래를 방문하여 산전검사로 갑상선 기능검사를 실시한 산모를 대상으로 하였다. 모든 대상 산모는 초음파로 임신주수를 확인하였으며, 단태아 임산부 만율 대상으로 하였다. 갑상선 질환을 앓았거나, 앓고 있는 산모, 1형 당뇨병 또는 자가면역질환이 있는 산모, 임상적으로 갑상선 질환이 의심되는 산모와 갑상선자가항체가 양성인 산모, 외국인 산모는 제외하였다. TSH, free T4를 측정하였으며, 각 임신기간을 월별, 분기별로 나누어서 평균값, 중간값, 정상범위(2.5th~97.5th percentile)를 구하였다. 결과: 대상산모는 총 265명이었다. 이중 임신 1삼분기에 94명, 2삼분기에 49명, 3삼분기에 122명이 포함되었다. TSH의 정상범위는 임신 1, 2, 3삼분기에 각각 0.03~2.72, 0.27~2.29, 0.03~2.88 mIU/L였으며, FT4는 4.50~19.75, 4.70~12.98, 5.07~11.84 pg/mL였다. 결론: 향후 연구를 통하여 임신 분기별 정상값 뿐만이 아니라 더 세분화하여 각 임신 개월에 따른 혹은 주수에 따른 정상값을 정하고 그에 따라 갑상선질환을 조기에 발견하고 치료함으로 산모와 태아의 예후 향상에 도움을 주어야 하겠다. Purpose: To determine the means, medians and reference intervals for TSH (thyroid-stimulating hormone) and fT4 (free thyroxine) for each month of gestation and for three trimesters in Korean pregnant women. Methods: Serum samples were collected from 265 pregnant women with singleton gestation. Levels of TSH, fT4 were measured by immunoassay. After exclusion of subjects with positive anti-microsomal autoantibodies, the means, medians and reference intervals based on 2.5th and 97.5th percentiles for TSH, fT4 were determined. Results: The study population consisted of 94 women in first trimester, 49 women in second trimester, and 122 women in third trimester. The trimester-specific reference intervals were: TSH (1st trimester: 0.03~2.72, 2nd: 0.27~2.29, and 3rd: 0.03~2.88 mIU/L), fT4 (1st trimester 4.50~19.75, 2nd: 4.70~12.98 and 3rd: 5.07~11.84 pg1mL). fT4 levels were significantly lower in the second and third trimesters. TSH levels were lower in the first trimester than second and third trimester, with gradual elevation in the second and third trimester. Conclusion: Levels of TSH, fT4 during pregnancy differ from those in non-pregnant women. Gestational age specific reference intervals will play a cental role in screening and diagnosis of thyroid disorders. Further studies for normal reference ranges during pregnancy are needed to create reference intervals in Korean pregnant women.

태반조기박리의 임상적 고찰

서민정 ( Min Jung Suh ),김옥경 ( Ok Kyoung Kim ),김두만 ( Du Man Kim ),유희정 ( Hee Jeong Yu ),박철훈 ( Cheol Hoon Park ),노덕영 ( Duck Yeong Ro ),김태응 ( Tae Eung Kim ) 대한주산의학회 2006 Perinatology Vol.17 No.1

목적 : 태반조기박리는 응급처치를 요하는 산과적 질환이나 현재로써는 이 질환을 임신 중 예견할 수 있는 진단적 방법이 없으므로, 본 연구는 환자의 기록을 임상적으로 고찰하고 기존 연구 문헌과 비교하여 산모와 태아의 합병증을 감소시키기 위하여 실시하였다. 방법 : 1991년 1월 1일부터 2003년 12월 31일까지 시행된 20,483예의 분만 중 태반조기박리로 진단된 80예의 임상 자료들을 분석하였다. 결과 : 13년 동안 태반조기박리의 발생 빈도는 0.4%였고, 97.5%가 임신 28주 이후에 발생하였다. 원인적 요소를 알 수 없는 경우가 67.5%로 나타났고, 임신성 고혈압이 동반된 경우가 22.5%의 빈도를 보였다. 임상 증상은 자궁내 태아 사망 10예를 포함한 질출혈이 46.3%, 하복부 통증 33.75 %, 태아 긴박증 10%, 조기 진통 5%를 보였다. 과반수의 산모에서 분만 전에 태반조기박리의 진단이 가능하였고, 제왕절개율은 93.8%였다. 태반 박리 정도에 따른 태아 생존율은 경도는 94.1%, 중등도는 84.6%였으나, 중증의 경우는 14.3%로 낮았다. 아울러 태반 박리 정도에 따른 태아의 1분/5분 Apgar score는 경도, 중등도, 중증에서 각각 5.9±2.5점/7.5±2.2점, 5.5±2.7점/7±2.8점 및 1.3±2.4점/1.3±3.0점으로 경도와 중등도의 태반조기박리 때보다 중증의 태반조기박리 때 1분/5분 Apgar score가 각각 유의하게 낮았다(p<0.01). 본 연구에서 산모가 사망한 예는 없었다. 결론 : 본 연구에서 태반조기박리의 원인적 요소를 알 수 없는 경우가 2/3로 임신성 고혈압의 원인적 요소나 임상증상의 파악이 치료의 중요한 지침을 제공한다고 생각된다. 또한 태반조기박리로 인한 태반기능부전은 태아에게 중대한 위험요소로 나타났으며, 이에 태반조기박리로 의심이 되는 경우는 박리가 더 이상 진행되지 않도록 즉각적인 분만을 시도함과 아울러 필요한 경우 미숙아 분만에 대한 관리를 준비는 것이 태아의 합병증을 줄이기 위하여 중요하다고 할 수 있겠다. Objective : Placental abruption is one of the obstetric hemorrhage diseases that needs emergent treatment. But there is no predictable tool for placental abruption at present, we clinically analyzed its incidence, etiological factors, signs and symptom and neonatal outcome for reducing complications of this disease. Methods : The data presented here were based on 80 cases of placental abruption among 20,483 deliveries during 13 years of period from January, 1991 to December, 2003. Results : The incidence of placental abruption was 0.4%. Most of cases (97.5%) occurred over 28 weeks of gestational age. The incidence of unknown etiological factor was 67.5% and pregnancy-induced hypertension was related in 22.5% of cases. The most common signs and symptom was vaginal bleeding (46.3%). Lower abdominal pain (33.8%), fetal distress (10%), premature labor (5%) were also noted. The half of the patients was diagnosed before delivery and the mode of delivery was cesarean section in 93.8%. The survival rate of newborns in severe degree group (14.3%) of placental abruption was lower than that of mild degree group (94.1%) or moderate degree group (84.6%). Additionally, Apgar scores at 1min and 5min of newborns in severe degree group (1.3±2.4/1.3±3.0) were significantly lower than that of mild degree group (5.9±2.5/7.5±2.2) or moderate degree group (5.5±2.7/7±2.8) (p<0.01). There was no maternal death in our study. Conclusion : Because the etiological factor of this disease was uncertain in two thirds of cases, comprehension of etiological factor such as pregnancy-induced hypertension and signs and symptom is emphasized. Bleeding and uteroplacental insufficiency caused by placental abruption affect fetal jeopardy in severe cases. Accurate diagnosis and adequate treatment including management of premature baby should be conducted in suspicious case of placental abruption for prevention of progression of this disease.

복강경을 통해 진단된 원발성 난관암

서민정 ( Min Jung Suh ),이성하 ( Sung Ha Lee ),김두만 ( Du Man Kim ),국일영 ( Ill Young Kook ),박세현 ( Sae Hyun Park ),박동춘 ( Dong Choon Park ),김대훈 ( Dae Hoon Kim ),윤주희 ( Joo Hee Yoon ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.6

Malignant neoplasm of the fallopian tube is the rarest of the gynecologic cancers. Vaginal bleeding, vaginal discharge, and pelvic pain are the most common symptoms. Because of these non-specific symptoms, the diagnosis of this Least common neoplasm is rarely made before Laparotomy. The tumor is typically unilateral and has histologic subtypes, endometrioid and serous adenocarcinoma being the most common subtypes. Surgery, clearly the mainstay of treatment, is also the first approach to diagnosis. The procedure of choice is total abdominal hysterectomy with bilateral salpingo-oopho-rectomy. We had experienced one patient with primary tubal cancer, successfully evaluated with Laparoscopy. And then we intend to report the case of the above patient and have a brief discussion about that.

정상 한국인에서 연령증가에 따른 혈장 Dehydroepiandrosteronesulfate ( DHEA-S ) 농도 및 DHEA - S / cortisol 비의 변화

박성우,유형준,임성희,최문기,유재명,박민숙,이권엽,박철수,김철홍,김현규,김두만,박규용 대한내분비학회 1997 Endocrinology and metabolism Vol.12 No.2

Backgroud: DHEA-S is the most abundant steroid hormone in circulation, and primarily secreted from the adrenal cortex, but its physiological role is little known. One of the characteristic features of DHEA-S is progressive decrement of plasma DHEA-S level with advancing age, in contrast, plasma levels of other adrenal hormones are not chaging or littie decreasing. To grasp the trends of plasma DHEA-S level and DHEA-S/cortisol ratio by age in healthy Korean, we measured the plasma DHEA-S levels and DHEA-S/cortisol ratios in healthy Korean. Methods: Healthy Korean(men: 99, women: 102, age range: 15-97 year old)were studied. Subjects were not taking drugs(such as glucocorticoid or androgenic medication) or cigarettes known to modify the plasma level of DHEA-S and cortisol, and had no evidence of hepatic, renal disease or hyperlipidemia as determined by serum lipid, bilirubin, SGOT, SGPT, BUN, creatinine. Data were analyzed by 10-year age group for men and women: i.e, 10-19, 20-29, 30-39, 40- 49, 50-59, 60-69, 70-79, 80-89 and 90 year or more. Plasma DHEA-S levels were measured by using a commercially available RIA kit with 125I labeled-DHEA-SO4(Coat-A Count DHEA-SO4), and for the measurement of plasma cortisol levels, commercial Gamma Coat TM[125I] Cortisol Radioimmunassay Kit was used. Results:. 1) In both men and women, plasma DHEA-S level showed high interindividual variation within the same age group. 2) There were individual sex differences in plasma levels of DHEA-S, in all age groups, plasma DHEA-S levels were significantly higher values for men than for women. 3) Maximum plasma DHEA-S levels(men; 237+-3.35 ug/dL, women; 108+-17.5 ug/dL) were at third decade in both men and women. 4) Both men and women showed the continuous decline in plasma DHEA-S level with age. These age-related decline was more prominent in men than in women(men; y= -3.152 * +292.6, r2= 0.8459, P$lt;0.05, women; y= -1.417 * +143.3, r2 = 0.7278, P$lt; 0.05). 5) As an index of aging, there was no stastical difference between DHEA-S and DHEA- S/cortisol ratio. Conclusion: In healthy Korean, there were high interindividual variation of plasrna DHEA-S levels. In both men and women plasma DHEA-S level was peak at third decade, and from when it declined progressively with age. These results suggest that although the reliability of single plasma DHEA-S measurement are limited, the decline of DHEA-S with advancing age might be a specific marker of endocrinologic hormonal milieu(aging index). Also, concerning to individual adrenal secreting capacity, we measured DHEA-S/cortisol ratio. But we did not found that plasma DHEA-S/cortisol ratio is superior to the plasma DHEA-S level as an aging index. (J Kor Soc Endocrinol 12:245-254, 1997)