인슐린비의존성 당뇨병환자에서 혈청 4 형 Collagen - 7S 의 의의

김영태(Young Tae Kim),한영찬(Young Chan Han),이정해(Jeong Hae Lee),김진곤(Jin Gon Kim),장태종(Tai Jong Jang),김윤권(Youn Kwon Kim),김소연(So Yon Kim),이권전(Gwon Jun Lee) 대한내과학회 1995 대한내과학회지 Vol.48 No.6

N/A Objectives: Thickening of basement membrane in capillaries and small vessels is a characteristic change in diabetic microangiopathy. It is improtant to observe dynamics of basement membrane metabolism in progression of this complication. Recently the component of basement membrane, collagen type IV-7S, can be detected in human sera by radioimmunoassays, Serum concentrations of collagen type IV was increased in diabetic patients and streptozotocin-induced diabetic rats. For the assessment of diabetic complication, we measured serum collagen type IV levels in non-insulin-dependent diabetic patients, comparing them with complications and durations of diabets mellitus. Methods: We measured serum collagen type IV levels in 94 non-insulin-dependent diabetic patients with or without clinical signs of retinopathy, nephropathy and in 32 healthy subjects without any serologic abnormality. We compared serum collagen type IV levels with degrees of complications and durations of diabets mellitus, Results: Serum concentrations of collagen type IV were significantly higher in diabetic patients than in healthy subjects. Serum collagen type IV levels were increased in patients with proteinuria, especially higher in patients with microproteinuria than in patiens without microproteinuria. Serum collagen type IV levels in patients with macroproteuinuria were significantly higher than in patients with microproteinuria. In patients with diabetic retinopathy, serum collagen type IV levels were significantly increased. Patients with proliferative retinopathy showed significant high levels of serum collagen type IV. Serum concentrations of collagen type IV were increased proportionately to the length of duration of diabetes mellitus. Conclusion: Serum collagen type N seems to be a useful, nonivasive, reproducible marker for assessment of the activity or progression of diabetic microangiopathy.

만성 신부전 환자에서 발생한 대장암과 유사한 거대세포바이러스 대장염 1예

김준환 ( Jun Hwan Kim ),김윤권 ( Youn Kwon Kim ),정준오 ( Jun Oh Jung ),서승오 ( Seong O Suh ),이세한 ( Se Han Lee ),고유진 ( Yu Jin Ko ),박재현 ( Jae Hyun Park ),유서희 ( Seo Hee Ryu ),유지원 ( Ji Won Yoo ) 전북대학교 의과학연구소 2012 全北醫大論文集 Vol.36 No.2

Cytomegalovirus (CMV) colitis is common among immunocompromised patients, those with Human Immunodeficiency Virus (HIV) infection, those undergoing immunosuppressant therapy after organ transplantation, those undergoing anti-cancer chemotherapy and long-term steroid users. Though some patients with chronic renal failure also have a defective immune response, CMV colitis is extremely rare in them. Colonoscopy in patients with CMV colitis usually shows diffuse or localized ulceration although mucosal friability, erosions, hemorrhage and plagues such as pseudomembranes may be observed. Rare cases of discrete gastrointestinal mass lesions caused by CMV have been also reported. A 69 year-old male with chronic renal failure who was undergoing hemodialysis therapy visited our hospital for regular checkup. He had no symptoms but his colonoscopic exam showed 2cm sized mass like lesion suggesting coloncancer. Pathologic reports revealed multiple inclusion bodies with CMV on immunohistochemistry. He was finally diagnosed as having CMV colitis. A colonoscopic follow-up showed complete healing of the mass lesion and he is doing well now without further treatment. Although CMV colitis is rarely associated with chronic renal failure and mass formation, it could be considered.

혈액투석 환자에서 발생한 신장 혈종과 자발성 비장 파열의 1예

허소정 ( So Chong Hur ),김윤권 ( Youn Kwon Kim ),정준오 ( Jun Oh Jung ),이세한 ( Se Han Lee ),유서희 ( Seo Hee Ryu ),심형훈 ( Hyoung Hun Sim ),윤창용 ( Chang Yong Yun ) 전북대학교 의과학연구소 2012 全北醫大論文集 Vol.36 No.2

혈액 투석 중인 환자에서의 자발성 비장출혈은 요독성 출혈 경향과 항혈소판제, 투석중 헤파린 사용 등과 연관되어 발생할 수 있으며 매우 드물게 보고되고 있다. 저자들은 혈액 투석 중인 환자에서 최근 외상병력 없이 새로이 발생한 자발성 비장 출혈을 경험하였다. 말기 신부전으로 혈액 투석중인43세 남자가 투석 후 복부 전반의 찌르는듯한 통증을 주소로 내원하였다. 3개월전 발생한 자발성 우측 신장 혈종으로 보존적 치료 중이었으며 항응고제를 복용하고 있지 않았다. 혈압은 152/88 mmHg, 맥박 78 회/분이었고 결막은 창백하고 복부 전반에 걸친 압통과 반발통이 있었다. 복부 전산화 단층 촬영에서 비장 혈종과 다량의 복강 내출혈을 보여, 비장 절제술을 시행 받고 현재혈액투석하며 경과 관찰 중이다. Spontaneous splenic rupture is a rare disease. Dialysis patients with chronic renal failure can undergo spontaneous splenic hemorrhage caused by uremic coagulopathy, heparin used in hemodialysis, infection, amyloidosis. We report spontaneous splenic rupture in a 43year-old man undergoing hemodialysis for end-stage renal disease (ESRD). After hemodialysis he was admitted with complaints of pricking whole abdominal pain and anorexia. He had undergone renal hematoma 3months ago without recent trauma history and had been managed conservatively without using anticoagulant and anti platelet agents during hemodialysis. Blood pressure was 152/88 mmHg, heart rate was 78 bmp. White blood cell count was 8,600/μL, hemoglobin was 6.6 g/dL, platelet was 121,000/μL, PT INR was 1.37 and aPTT was 30.4sec. Abdominal CT scan showed splenic hematoma and large amount of hemoperitoneum. An emergent splenectomy was performed without immediate complications related to the surgical procedures. Pathology report demonstrated that spleen had normal tissue with hematoma. The postoperative course was uneventful. The patient has been undergoing hemodialysis till now. Spontaneous spleen rupture, a rare disease can cause life threatening situation and we should make early diagnosis and management of spontaneous spleen rupture when evaluating patients undergoing hemodialysis who present with abdominal pain and acute onset of anemia.

당뇨병 환자에서 Tc - 99m - DISIDA Scintigraphy 를 이용한 담낭의 기능분석

황인섭(In shup Hwang),류광현(Kwang Hyun Rhu),김홍남(Hong Nam Kim),노영호(Young Ho Rho),한신(Sin Han),김윤권(Youn Kwon Kim),김소연(So Yon Kim),조민구(Min Koo Cho),이권전(Gwon Jun Lee) 대한내과학회 1998 대한내과학회지 Vol.54 No.4

N/A Objectives : Diabetic autonomic neuropathy is a common complication of long standing diabetes mellitus and is well known to induce the motor dysfunction of cardiovascular system, genitourinary system and digestive system. Although many studies have done to evaluate the diabetic autonomic neuropathy, gallbladder motor function and biliary dynamic study to evaluate the change of gallbladder function in diabetic patients is relatively rare. This study was performed to measure the gallbladder ejection fraction using Tc- 99m-DISIDA with fatty meal in order to evaluate the gallbladder motor function in diabetic patients and to examine the usefulness of it in analyzing diabetic autonomic neuropathy. Methods : 51 diabetic patients(males 31, females 18, mean age 57yr(36-77yr)) and 1H control subjects(males 14, females 4, mean aged 47yr(31-70yr)) without gallstone and impaired liver function were enrolled in our study. Also the diabetic patients were categorized by age, disease duration, body weight and diabetic complications such as retinopathy, peripheral neuropathy and cardiovascular autonomic neuropathy accompanying with or not. Results : 1) Median value and interquartile range of gallbladder ejection fraction(%) were 66%(48-79%) in diabetic patients group and 75%(64-80%) in control subjects. There was no statistically significant difference between the two groups, but the mean value of diabetic patients was slightly lower than that of control subjects. 2) There was no significant difference between the two groups in mean value of gallbladder ejection fraction in every age group(P>0.05). 3) Median value of gallbladder ejection fraction in diabetic groups with less than 10 years of duration (both under 5 years and 5 to 10 years groups) was similar to that of control subjects. However in patients whose diabetic conditions last more than 10 years, the median range of gallbladder ejection fraction was significantly lower than that of control subjects(P<0.05). 4) Median range of gallbladder ejection fraction in obese diabetic patients group was significant lower than those of control subjects and non- obese diabetic patients(p<O.C6). 5) Median value of gallbadder was lower in diabetic patients group with complications like retinopathy, peripheral neuropathy or cardiovascular autonomic neuropathy (p<0.05) in comparison with those of control subjects and diabetic patients group without diabetic complication (p>0.05). Also seven diabetic patients whose gallhladder ejection fraction was reduced under,35% have had at least two diabetic complications. Conclusion : We observed that gallbladder ejection fraction of diabetic patients was reduced compared with that of control subjects. This is due to the reduced gallbladder muscle contractility resulting from diabetic autonomic dysfunction. These results suggest that the assessment of gallbladder ejection fraction using 99m- Tc-DISIDA would be useful to diagnose diabetic autonomic neropathy.

벤조디아제핀 복용 중 발생한 저나트륨혈증에 의한 횡문근융해증 1예

정재혁 ( Jae Hyeok Jeong ),조재현 ( Jae Hyun Cho ),유창민 ( Chang Min Yu ),서승오 ( Seong O Suh ),안석진 ( Seok Jin Ahn ),정준오 ( Jun Oh Jung ),김윤권 ( Youn Kwon Kim ) 대한내과학회 2008 대한내과학회지 Vol.75 No.6

저나트륨혈증은 횡문근융해증의 드문 원인이다. 보고된 증례들 중 대다수가 정신병으로 신경이완제를 복용 중인 경우들이었는데, 정신병과 신경이완제의 복용이 저나트륨혈증 또는 이의 교정으로 인한 횡문근융해증의 발생에 기여하는 것으로 생각된다. 현재까지의 보고들에서 원인이 되었던 신경이완제는 거의 모두가 항정신병 약물이었고, 단 1건의 증례보고에서만 벤조디아제핀이 관여하였을 것으로 설명하였다. 이에 저자들은 벤조디아제핀을 복용 중이던 급성 정신병의 병력이 의심되는 환자에서 저나트륨혈증의 교정 중 횡문근융해증이 발생한 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Hyponatremia is rarely reported to cause rhabdomyolysis and there has been only one case report on rhabdomyolysis due to hyponatremia, possibly complicated by benzodiazepines. We experienced a case of rhabdomyolysis due to hyponatremia during the use of benzodiazepines in a patient with an acute psychosis. A 60-year-old man was admitted to the emergency room due to altered mentality. He had been taking benzodiazepines for 1 month because of insomnia, uneasiness, and depression. His initial blood chemistry revealed severe hypotonic hyponatremia in the absence of polydipsia, edema, and features of dehydration. While correcting the hyponatremia, rhabdomyolysis developed with no evidence of trauma, seizures, or tremor. In patients with acute psychosis, the development of rhabdomyolysis due to hyponatremia or its correction should not be underestimated and should be assessed thoroughly. Clinicians also need to be aware of the potential risk of benzodiazepines for the development of rhabdomyolysis. (Korean J Med 75:718-722, 2008)

혈소판 감소증으로 발견된 사람면역결핍 바이러스 감염증 1예

오유미 ( Yu Mi Oh ),조재현 ( Jae Hyun Cho ),안수민 ( Soo Min Ahn ),윤창용 ( Chang Yong Yun ),심형훈 ( Hyoung Hun Sim ),김소연 ( Soyon Kim ),김윤권 ( Youn Kwon Kim ),유창민 ( Chang Min Yu ),이세한 ( Se Han Lee ) 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.1

Although hematologic abnormalities are common in patients with HIV infection, there are few reports of HIV infected patients who first presented with severe thrombocytopenia (<25,000 / μL). We experienced a case of HIV-infected patient presenting only severe thrombocytopenia. There was no other cause that can cause thrombocytopenia. He was treated with antiretroviral therapy. And thrombocytopenia improved after 7 months..

소화기 ; 집단생활하는 경찰부대에서 A형 간염바이러스의 감염력 및 발병력 연구

현희재 ( Hee Jae Hyun ),박소연 ( So Yeon Park ),최순옥 ( Soon Uk Choi ),안주영 ( Ju Young Ahn ),정준오 ( Jun Oh Jung ),임수진 ( Su Jin Lim ),유지원 ( Ji Won Yoo ),박상준 ( Sang Jun Park ),김윤권 ( Youn Kwon Kim ),김영중 ( Young Ju 대한내과학회 2011 대한내과학회지 Vol.80 No.1

목적: 성인에서 현증 A형 간염 발생이 증가하면서 공중보건 문제가 되고 있다. A형 간염의 발생률과 항체 양성률에 관한 연구는 많이 보고되고 있으나, A형 간염바이러스의 감염력이나 발병력에 대한 연구는 거의 없는 실정이다. 본 연구는 집단생활하는 경찰부대의 A형 간염 유행의 2차 감염률과 발병률을 통해서 A형 간염바이러스의 감염률과 발병률을 연구하였다. 방법: 대원 3명이 A형 간염으로 입원치료하였던 전투경찰부대의 부대원 중 초발환자를 제외하고 이후에 발생한 A형 간염 환자 2명을 포함한 70명(이하 환자 접촉군)을 대상으로, A형 간염 임상 증상 동반 유무와 과거 A형 간염 백신 접종 여부를 포함한 병력청취, 간기능검사를 포함한 혈액검사, 혈청검사를 3번째 현증 A형 간염 환자의 퇴원일에 검사하였으며, 잠복기를 감안하여 3번째 현증 A형 간염 환자의 황달 발현시점 2개월 후에 병력청취를 포함한 동일한 검사를 반복 시행하였다. A형 간염이 발생치 않은 다른 부대의 전투경찰대원 75명(이하 환자 비접촉군)을 비교 연구하기 위하여 병력청취 및 동일한 검사를 시행하였다. 전체 감수성 있는 긴밀접촉자 중 HAV 감염자의 비율을 바이러스의 2차 감염률로, HAV 감염자 중에서 현증 A형 간염으로 진단된 자의 비율을 발병률로 정의하였다. Background/Aims: Acute viral hepatitis A infection in adults is an emerging public health problem in Korea. The infectivity and pathogenicity of hepatitis A virus (HAV) among people living in close contact have not been studied previously. This study investigated the secondary attack rate and pathogenicity rate of HAV during an outbreak among auxiliary police in a communal living setting in Korea. Methods: A total of 70 people in close contact with a hepatitis A patient (index case) were enrolled in the study, which included a thorough oral history, physical examination, and laboratory testing. The subjects were part of an auxiliary police unit living in a communal setting (HAV contact group). Serum antibody titers were measured in the contact group at two points during the study. Subjects in another auxiliary police unit without exposure to hepatitis A were examined as a control group (HAV non-contact group). The secondary attack rate and pathogenicity rate were calculated from the data. Results: In the HAV non-contact group, none of the subjects had anti-HAV antibodies. In the HAV contact group, three subjects had both IgM and IgG anti-HAV antibodies, and two had only IgG anti-HAV antibodies. Two of three HAV-infected subjects were treated for hepatitis A. Conclusions: The secondary attack rate of HAV was 4.3~7.1% and the pathogenicity rate was 40~66.7% in the group of young adults. (Korean J Med 2011;80:63-67)

Gitelman씨 증후군 1예

차영학,송명준,신요식,김성민,김영욱,김윤권,김소연,김영중,조민구,이권전 全南大醫大 2001 전남의대학술지 Vol.37 No.3

전투 경찰에서 A형 간염 발생률과 항체 양성률

이정민,박형기,최규영,김현근,정준오,서승오,김은실,김윤권,김소연,김영중 대한감염학회 2007 감염과 화학요법 Vol.39 No.6

목적 : 우리나라에서 A형 간염은 표본 감시를 통해서 질병관리본부로 보고되고 있으나 전체 모집단을 규정할 수 없어 A형 간염 발생률을 조사하기는 어렵다. 이에 저자들은 단일 집단인 전투 경찰을 대상으로 연간 현증 A형 간염의 발생률 및 항체 양성률을 조사하고자 하였다. 재료 및 방법 : 의무기록 검색을 통하여 2002년부터 2006년까지 국립경찰병원에 입원하여 현증 A형 간염으로 진단된 전투 경찰을 조사하였다. 그리고 전투 경찰 507명을 대상으로 A형 간염 바이러스 항체를 검사하였다. 결과 : 2002년부터 2006년까지 전투 경찰에서 연간 현증 감염와 발생률은 10만 명당 10.6-14.8명이었다. 건강한 전투 경찰의 A형 간염 바이러스 항체 양성률은 0.6% (3/507)이었다. 결론 : 전투 경찰에서 연간 현증 A형 간염 발생률은 10만 명당 10명 이상이며, 전투 경찰의 A형 간염 항체 양성률은 1999년 30.2%에서 현패 0.6%로 현저히 낮아졌다. 전투 경찰에서 A형 간염 백신을 기본 접종할 것을 고려해야 한다. Background: In Korea, cases with hepatitis A have been reported to Korea Centers for Disease Control and Prevention through the sentinel surveillance system. However, it was difficult to study the exact nation-wide incidence of hepatitis A infection. We studied the incidence of clinically apparent hepatitis A infection and the seroprevalence of anti-HAV IgG among auxiliary police officers. Materials and methods : We analyzed clinically apparent and hospitalized hepatitis A patients from 2002 to 2006 in National Police Hospital via medical records. We also measured anti-HAV IgG antibody from 507 auxiliary police officers. Results: The estimated annual incidence of clinically apparent hepatitis A infection among auxiliary police officers was 10.6-14.8 cases per 100,000 population from 2002 to 2006. The overall anti-HAV IgG seropositive rate among auxiliary police officers was 0.6% (3/507). Conclusion: Among auxiliary police officers, the estimated annual incidence of clinically apparent hepatitis A infection was above 10 cases per 100,000 population and the positive rate of anti-HAV IgG was very low. The results were comparable to those in the low endemicity countries. The routine HAV vaccination among auxiliary police officers might be suggested.

성인에서의 Alport 증후군 1예

김학수,김영중,오영하,노영호,안민,박병익,차영학,김윤권,전종구,안현석 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.2

Alport's syndrome is a hereditary disorder whose incidence is 1 in 10,000 in general population, and, majority are developed in childhood, so it is rare to develop in adults. This syndrome consists of hematuria, sensorineural hearing loss, and lenticonus, in classic form. However, there are many atypical forms which have not all clinical manifestations. Although most asymptomatic hematuria in adults results from IgA nephropathy(Berger's disease) or thin basement disease(benign hematuria), Alport's syndrome should be considered as a cause of hematuria. The authors experienced a case of Alport's syndrome in a 21-year-old man who showed only hematuria and proteinuria, and who was diagnosed by history, family history, audiogram, and kidney needle biopsy. So, we report this case with a review of literature.