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한 종합병원에 입원한 노숙인 당뇨병 환자의 당뇨관리 실태와 동반 질환
범선희 ( Sun Hee Beom ),오무경 ( Moo Kyung Oh ),안철우 ( Chul Woo Ahn ) 대한내과학회 2014 대한내과학회지 Vol.86 No.5
Background/Aims: As an underprivileged population, homeless people have a higher incidence of morbidity and mortality than do non-homeless people. Diabetes mellitus is a chronic disease associated with high complication rates; its incidence is increasing rapidly and it requires prompt, adequate treatment and care. Therefore, we investigated the quality of medical care provided to homeless diabetics in a general hospital and comorbidities associated with diabetes. Methods: Between March 25, 2011 and December 31, 2012, we retrospectively investigated the medical records of the diabetes patients at a general hospital in Seoul. We assigned the patients into two groups: homeless (n = 82) and non-homeless (n = 242) patients. We subsequently compared the clinical and laboratory findings, comorbidities, and complications between the two groups. Results: The homeless diabetics received treatment less regularly than the non-homeless patients and were diagnosed with diabetes while visiting the hospital for the treatment of other diseases. The homeless patients had higher glycated hemoglobin A1c levels than the non-homeless patients. The homeless patients had a higher rate of other diseases, such as peripheral artery disease, acute infectious disease, intracranial hemorrhage, and pulmonary tuberculosis; a higher incidence of acute infectious disease (odds ratio [OR], 15.671; 95% confidence interval [CI], 5.115-48.070); and a higher prevalence of pulmonary tuberculosis (OR , 6.423; 95% CI, 1.785-23.116) than the non-homeless patients, as determined by multivariate analysis. Conclusions: Comorbid acute infectious disease and pulmonary tuberculosis were found more frequently in homeless diabetes patients presenting to the hospital than in non-homeless diabetes patients. Therefore, attention should be paid to this differentiating factor. (Korean J Med 2014;86:585-592)
증례 : 혈액종양 ; 범혈구감소증과 높은 혈청 비타민 B12 농도를 보인 거대적아구성 빈혈 1예
범선희 ( Sun Hee Beom ),이재명 ( Jae Myung Lee ),이상혁 ( Sang Hyuk Lee ),홍석호 ( Suk Ho Hong ),이호준 ( Ho Jun Lee ),이대희 ( Dae Hee Lee ),윤성민 ( Seong Min Yoon ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S
혈청 비타민 B12 (코발라민) 농도가 낮은 경우 비타민 B12 결핍에 의한 거대적아구성 빈혈로 진단이 가능하며 때때로 범혈구감소증을 보이기도 한다. 혈청 비타민 B12 농도가 정상이어도 환자가 증상을 보이고 코발라민의 대사물인 혈청 호모시스테인이나 소변 메틸말로니산의 농도가 상승되어 있는 경우도 진단될 수 있다. 저자들은 범혈구감소증을 보이는 거대적아구성 빈혈의 진단에서 혈청 비타민 B12 농도가 높은 경우를 경험하였기에 이를 보고한다. Low serum vitamin B12 (cobalamin) level is a valuable indicator of cobalamin-deficiency megaloblastic anemia, which sometimes presents as pancytopenia. It can also be diagnosed by cobalamin deficiency if the patient shows related clinical symptoms and increased serum homocysteine or urine methylmalonic acid, metabolites of cobalamin, although the serum cobalamin level may be normal. We report a case of cobalamin-deficiency megaloblastic anemia presenting as pancytopenia with an increased serum vitamin B12 level. (Korean J Med 77:S1314-S1317, 2009)
김순애,심우호,이은희,이영미,범선희,김은석,유정선,남지선,조민호,박종숙,안철우,김경래 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.2
Background: Sitagliptin is a highly selective dipeptidyl peptide-4 (DPP-4) inhibitor that increases blood levels of active glucagon-like peptide (GLP)-1 and glucose-dependent insulinotrophic polypeptide (GIP), resulting in increased insulin secretion. While studies conducted in other countries have indicated the efficacy and safety of using sitagliptin to treat type 2 diabetes mellitus (T2DM), its predictors of effects to sitagliptin are not well understood. Therefore, we evaluated the predictive clinical parameters for the therapeutic benefits of sitagliptin when added to an ongoing metformin or sulfonylurea therapy in Korean T2DM subjects. Methods: We obtained data from 251 Korean T2DM subjects who had recently started taking sitagliptin as add-on therapy. Exclusion criteria included any insulin use. Changes in HbA1c (ΔHbA1c) and fasting plasma glucose (ΔFPG) were assessed by comparing baseline levels prior to sitagliptin administration to levels 12 and 24 weeks after treatment. Responders were defined as subjects who experienced decrease from baseline of >10% in ΔHbA1c or >20% in ΔFPG levels at 24 weeks. Results: We classified 81% of the subjects (204 out of 251) as responders. The responder group had a lower mean body mass index (23.70±2.40 vs. 26.00±2.26, P≤0.01) and were younger (58.83±11.57 years vs. 62.87±12.09 years, P=0.03) than the non-responder group. Conclusion: In Korean T2DM subjects, sitagliptin responders had lower body mass index and were younger compared to non-responders.
증례 : 혈액종양 ; 10년이 지나 사지 전체에 재발한 전형적 카포시 육종 1예
이재명 ( Jae Myung Lee ),범선희 ( Sun Hee Boum ),홍석호 ( Seuk Ho Hong ),이상혁 ( Sang Hyuk Lee ),윤수진 ( Su Jin Yoon ),이윤경 ( Yun Kyung Lee ),윤성민 ( Seong Min Yoon ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S
저자들은 임상적으로 면역 저하가 없는 환자에서 일측 하지에 발생한 카포시 육종으로 진단되었고, 수술 및 방사선 치료를 통해 근치된 상태로 지내오던 중 10년이 지나 양측상, 하지 모두에서 동시에 재발한 전형적 카포시 육종에 대해 ABV 복합항암화학요법으로 치료한 경험을 문헌고찰과 함께 보고한다. Kaposi`s sarcoma is a multicentric angioproliferative tumor of endothelial cells that originates from skin and viscera. We report a 61-year-old man with relapsed classic Kaposi`s sarcoma on all extremities 10 years after complete remission. He was diagnosed with Kaposi`s sarcoma in 1996 and underwent successful therapy with amputation and radiotherapy. He presented with multiple purpuric nodules and plaques on both arms and legs without an immunodeficiency syndrome or transplantation history. The patient was treated with bi-weekly adriamycin, bleomycin, and vincristine chemotherapy for 10 months, but died from pulmonary complications. (Korean J Med 77:S1281-S1284, 2009)
홍석호,김봉룡,이재명,김성두,장유현,김혁중,범선희 대한소화기내시경학회 2009 Clinical Endoscopy Vol.39 No.5
Nasogastric tube insertion is a routine clinical procedure for nutritional support, gastric aspiration and decompression. Although it is generally a safe procedure, complication rates range from 0.3∼8%. Submucosal esophageal dissection is a rare disorder caused by mucosal tearing and bleeding between the mucosal and muscular layers of the esophagus, leading to their separation. We report a case of submucosal esophageal dissection secondary to the accidental iatrogenic intramural insertion of a nasogastric tube. 코위영양관 삽입술은 병원에서 영양공급 및 위 흡인이나 감압을 위해 흔히 시행하는 시술이다. 코위영양관 삽입술은 눈가림법으로 시행하는 비교적 안전한 시술이지만 삽입시 0.3∼8%에서 합병증이 발생할 수 있다. 식도점막하박리는 점막열창 및 출혈을 통해 점막하층과 근육층 사이가 분리되는 질환으로 저자들은 코위영양관 삽입후 발생한 식도점막하박리 1예를 경험하여 보고한다.