POEMS 증후군 1 예

백세현(Sei Hyun Baik),구양서(Yang Suh Koo),김상진(Sang Jin Kim),심완주(Wan Joo Shim),최동섭(Dong Seop Choi),김인선(In Sun Kim),정희진(Hee Jin Jeong) 대한내과학회 1992 대한내과학회지 Vol.43 No.2

A POEMS syndrome is a rare diaease of which main clinical characteristics are polyneuropathy, organomegaly, endocrinopathy, M proteins and skin changes. Although the proliferation of plasma cell is considered to do a pathogenetic role, the definite etiology and pathogenesis is still unclear. A 47years old woman who has been treated for valvular heart disease admitted to the hospital because of low extremity pain, walking disturbance, aggravation of exertional dyspnea and abdominal distention. She also complained of the anterior neck swelling and dark discoloration of skin. She had been suffered from diabetes mellitus for 5months. Inspite of repeated centesis of ascitic and pleural fluid with medical freatment for heart tailure, and administration of insulin and thyroid hormone for DM and hypothyroidism, dyspnia and abdominal distention did not improved. On the tenth day of admission, 2×2 cm sized palpable axillary lymph node biopsy was done and prednisolone was prescribed under the impression of POEMS syndrome. The findings of lymph node biopsy and bone marrow biopsy which was done 6weeks later was compatible with POKMS syndrome. In bone mar- row biopsy, most plasma cells which slightly increased in proportion were positive for IgA λ on immunohistochemical stain. There was a dramatic improvement of low extremity pain, edema, skin lesions and other symptoms after 10days use of prednisolone. But blood sugar level fluctuated although splitted doses of insulin were applied. General condition of the patient was improved continuosly, so she discharged with well being sense. We exprienced a case of POEMS syndrome in a 47years woman who has all major characteristics of the syndrome. We report this case with a review of literatures.

당뇨병의 예방과 의료인의 역할

백세현(Sei Hyun Baik) 대한내과학회 2002 대한내과학회지 Vol.62 No.5

N/A

원발성 알도스테론증에 대한 임상적 고찰

김용현(Yong Hyun Kim),이은종(Eun Jong Lee),최경묵(Kyung Muk Choi),김상진(Sang Jin Kim),유재명(Jae Myung Yoo),백세현(Sei Hyun Baik),최동섭(Dong Seop Choi) 대한내과학회 1995 대한내과학회지 Vol.48 No.5

Objectives: Primary aldosteronism is one of major causes of secondary hypertension that is characterized by hypertension with hypokalemia, suppressed plasma renin activity and elevated plasma aldosterone level due to excessive secretion of aldosterone from the adrenal. In Korea the first case was reported in 1968 and a clinical study of 10 cases was described in 1983. More cases of primary aldosteronism would have been diagnosed with the advanced method of measuring hormone level and abdominal CT scanning, but we cant find out more cases in the Korean literatures till now. So we performed this clinical study to evaluate systematic diagnostic method and effective treatment modality. Methods: We compared the clinical and laboratory characteristics and treatment outcomes between aldosterone producing adenoma and idiopathic hyperplasia in 15 cases of primary aldosteronism that were diagnosed and followed at Korea University Hospital from 1986 to 1993. Results: 10 cases out of 11 in which abdominal CT scan showed adrenal mass were confirmed as adenoma and remaining 1 case was diagnosed as hyperplasia pathologically, so total 5 cases of hyperplasia were diagnosed finally. Plasma aldosterone concentrations after 4 hours upright posture were increased in all 4 cases of bilateral hyperplasia and decreased or unchanged in 6 adenoma cases out of 7. The case number 6 patient showed increased plasma aldosterone concentration after upright posture in spite of adrenal mass lesion on abdominal CT scan and was diagnosed finally as renin-responsive adenom. 5 adenoma cases out of 10 are maintained normotensive state without medication and remaining 5 cases are taking antihypertensive medication Conclusion: After the diagnosis of primary aldosteronism by measurements of plasma renin activity and aldosterone concentration in hypertensive patient with hypokalemia, the differential diagnosis between aldosterone-producing adenoma and bilateral adrenocortical hyperplasia using upright posture test and abdominal CT scan will be helpful to determine the treatment modality. But occasionally, futher detailed diagnostic study is necessary in cases of small aldosterone producing adenoma that is not detected on abdominal CT scan and in cases of renin-responsive adenoma or glucocorticoid-suppressible aldosteronism.

갑상선 악성종양 및 양성종양에서 Fra - 1 표현에 대한 연구

김용현(Youg Hyun Kim),오정헌(Jeong Heon Oh),김난희(Nan Hee Kim),최경묵(Kyung Muk Choi),김상진(Sang Jin Kim),백세현(Sei Hyun Baik),최동섭(Dong Seop Choi),이응석(Eung Seok Lee) 대한내과학회 2000 대한내과학회지 Vol.59 No.4

Background : Differential diagnosis of thyroid nodule is important in deciding treatment modality and fine needle aspiration is a good method to do so. But, sometimes, it has limitation in use because of inadequate test material and difficulty in interpreting it. Among the study of oncogene and tumor suppresor gene on the origin of thyroid tumor, expression of Fra-1, one of AP-1 system, is increased in thyroid neoplasm. So there is a possibility that it would be used as a method for differential diagnosis of thyroid nodule. We tried to know whether presence or absence of Fra-1 expression can be used as a diagnostic method in differential diagnosis of thyroid nodule using immuno- histochemical(IHC) staining method.Methods : In 4 types of thyroid tumor that was confirmed by histologic diagnosis after operation(30 cases of papillary cancer, 10 cases of follicular cancer, 16 cases of follicular adenoma, 18 cases of adenomatous goiter), IHC staining method was performed to evaluate the expression of Fra-1.Results : In papillary and follicular thyroid cancer, the expression of Fra-1 was stronger than benign thyroid tumor, but there was no difference in Fra-1 expression between two types of carcinoma. Weak expression of Fra-1 was observed in all cases of follicular adenoma, and it was also weakly expressed in 6 out 18 cases of adenomatous goiter. Conclusion : The expression of Fra-1 was stronger in thyroid cancer than in benign thyroid adenoma, but it was impossible to differentiate thyroid cancer from benign thyroid adenoma by the presence or absence of Fra-1 expression using IHC staining method.(Korean J Med 59:398-403, 2000)

우리나라 당뇨병의 역학적 규모와 당뇨병 관리현황 파악을 위한 표본설계의 평가

이지성,김재용,백세현,박이병,이준영,Lee, Ji-Sung,Kim, Jai-Yong,Baik, Sei-Hyun,Park, Ie-Byung,Lee, June-Young 대한예방의학회 2009 예방의학회지 Vol.42 No.2

Objectives : An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. Methods : We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. Results : Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04%(95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. Conclusions : The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.

종설 : 우리나라 당뇨병의 역학적 특성 -대한당뇨병학회,건강보험심사평가원 공동연구 결과를 중심으로

박이병 ( Ie Byung Park ),백세현 ( Sei Hyun Baik ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.5

The aim of article is to introduce the current status of diabetes care and characteristics in diabetic patients in Korea, which is a joint report by Korean Diabetes Association (KDA) and Health Insurance Review Agency (HIRA) ("Diabetes in Korea 2007") and to review the recent published data about the current status of diabetes mellitus in Korea. (Korean Diabetes J 33:357-362, 2009)

99mTc - DTPA 및 Gamma Scintillation Camera를 이용한 사구체 여과율의 측정

이민재(Min Jae Lee),최재걸(Jae Gol Choe),백세현(Sei Hyun Baik),서원혁(Won Hyuck Suh) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1

N/A The radioisotopic measurement of glomerular filtration rate (GFR) has required analysis of serial blood or urine samples over several hours, and does not allow measurement of separate renal function unless separate catherterization of individual ureters is done. Gates described isotopic method for the measurement of global and unilateral GFR based on the determination by scintillation camera of the fraction of the injected dose of Tc-99m-diethylenetriaminepentaacetic acid (DTPA) present in the kidneys 2-3 minutes after its administration.We calculated GFR according to Gates' method in 58 adult patients with various levels of global renal function using Tc-99m DTPA and validated this technique by correlation with 24 hour creatinine clearance. A good correlation was observed between 24 hour creatinine clearance and GFR calculated by Gates' formula, with an r value of 0.91 (p〈0.01). We concluded that determination of GFR according to the Gates' formula allows good and reproducible prediction of GFR with great rapidity and simplicity rendering this technique suitable for clinical practice.

원발성 부갑상선 기능항진증에 대한 임상적 고찰

정광윤(Kwang Yoon Jung),이종수(Jong Soo Lee),최종욱(Jong Ouck Choi),백세현(Sei Hyun Baik) 대한두경부종양학회 1994 대한두경부 종양학회지 Vol.10 No.1

Primary hyperparathyroidism is rare disease entity which secretes parathyroid hormone in excessively resulting in hypercalcemia. It involves skeletal system, urinary tract, gastrointestinal tract, and central nervous system. Recently the determination of the serum calcium and parathyroid hormone level has become a routine laboratory test and the localization of involved gland by neck ultrasonogram and parathyroid gland substraction scan has reduced operative complications. For the purpose of improvement of diagnosis and treatment, the authors analyzed the clinical characteristics of 6 cases of primary hyperparathyroidism(adenoma 5 cases, carcinoma 1 case) during 10 years and report with literatures.

한국인 제2형 당뇨병 환자의 인슐린저항성과 베타세포 기능을 반영하는 지표로서 혈청 인슐린, 프로인슐린 및 프로인슐린/인슐린비율

김난희(Nan Hee Kim),오정헌(Jung Heon Oh),최경묵(Kyung Mook Choi),김용현(Young Hyun Kim),김상진(Sang Jin Kim),백세현(Sei Hyun Baik),최동섭(Dong Seop Choi) 대한내과학회 2000 대한내과학회지 Vol.58 No.1

Background : Although insulin resistance and decreased insulin secretion are characteristics of establised type 2 DM, which of these metabolic abnormalities is the primary determinant of type 2 DM is controversial. It is also not well known how insulin resistance and beta cell dysfunction influence serum insulin, proinsulin, proinsulin/insulin ratio in type 2 DM. Methods : We compared serum insulin, proinsulin, proinsulin/insulin ratio in type 2 diabetic patients and control subjects. We investigated the relationship between serum insulin, proinsulin, proinsuolin/insulin ratio and several biochemical markers which represent insulin resistance or beta cell function. Results : Proinsulin, total insulin, and proinsulin/insulin ratio were significantly higher in type 2 DM than control(p<0.001). In diabetic patients, proinsulin was correlated with fasting c-peptide(r=0.43, p=0.002), postprandial 2 hour blood glucose(r=0.213, p=0.05), and triglyceride(r=0.28, p=0.022). Total insulin was correlated with urinary albumin excretion rates(r=0.224, p=0.025) and body mass index(r=0.269, p=0.014). Proinsulin/insulin ratio was positively correlated with fasting c-peptide(r=0.236, p=0.031), fasting blood glucose(r=0.264, p=0.015), postprandial 2 hour blood glucose(r=0.277, p=0.001), and triglyceride(r=0.428, p<0.001). In control subjects, fasting insulin was correlated with triglyceride (r=0.366, p=0.002). Proinsulin/insulin ratio was correlated with age(r=0.241, p=0.044). Conclusion : The serum levels of insulin and proinsulin seems to be associated with several markers of insluin resistance. The proinsulin/insulin ratio might represent beta cell function rather than insulin resistance. But more studies are needed to clarify the mechanism of elevated proinsulin/insulin ratio in type 2 DM.(Korean J Med 58:67-74, 2000)

조직 생검으로 확인된 측두동맥염 1 예

송관규(Gwan Gyu Song),정문기(Moon Gi Chung),권오상(Oh Sang Kwon),박창규(Chang Gyu Park),백세현(Sei Hyun Baik),서홍석(Hong Seog Seo),오동주(Dong Joo Oh),이창홍(Chang Hong Lee),원남희(Nam Hee Won) 대한내과학회 1995 대한내과학회지 Vol.48 No.5

Temporal arteritis is an inflammatory disease of the elastic artery with unknown etiology. It usually affects patients over the age of 50, and is often associated with polymyalgia rheumatica. We have experienced a 66-year-old female patient with temporal arteritis who presented as a new onset headache and temporal artery abnormalities. Temporal artery biopsy was performed, which showed typical findings of temporal arteritis. To our knowledge, this is the first case of temporal arteritis in Korea. We hereby report a case of temporal arteritis with a brief review of literature.