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선춘식,민경완,이승엽,노경우,박세환,구보경,한경아 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.6
Background: Patients with type 2 diabetes have an increased risk of cardiovascular disease. Few studies have evaluated the cardiovascular disease (CVD) risk simultaneously using the United Kingdom Prospective Diabetes Study (UKPDS) risk engine and non-invasive vascular tests in patients with newly diagnosed type 2 diabetes. Methods: Participants (n=380; aged 20 to 81 years) with newly diagnosed type 2 diabetes were free of clinical evidence of CVD. The 10-year coronary heart disease (CHD) and stroke risks were calculated for each patient using the UKPDS risk engine. Carotid intima media thickness (CIMT), flow mediated dilation (FMD), pulse wave velocity (PWV) and augmentation index (AI) were measured. The correlations between the UKPDS risk engine and the non-invasive vascular tests were assessed using partial correlation analysis, after adjusting for age, and multiple regression analysis. Results: The mean 10-year CHD and 10-year stroke risks were 14.92±11.53% and 4.03±3.95%, respectively. The 10-year CHD risk correlated with CIMT (P<0.001), FMD (P=0.017), and PWV (P=0.35) after adjusting for age. The 10-year stroke risk correlated only with the mean CIMT (P<0.001) after adjusting for age. FMD correlated with age (P<0.01) and systolic blood pressure (P=0.09). CIMT correlated with age (P<0.01), HbA1c (P=0.05), and gender (P<0.01). Conclusion: The CVD risk is increased at the onset of type 2 diabetes. CIMT, FMD, and PWV along with the UKPDS risk engine should be considered to evaluate cardiovascular disease risk in patients with newly diagnosed type 2 diabetes.
선춘식,박영숙,정유민,최정호,손병관,안상봉,김성환,조윤주 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.6
Amyloidosis is a group of disorders characterized by the extracellular accumulation of insoluble, fibrillar proteins in various organs and tissues. It is classified, on the basis of the identity of the precursor protein, as primary, secondary, or familial amyloidosis. Gastrointestinal amyloidosis usually presents as bleeding, ulceration, malabsorption, protein loss, and diarrhea. However, gastric amyloidosis with gastric outlet obstruction mimicking linitis plastica is rare. We report a case of gastrointestinal amyloidosis with gastric outlet obstruction in a patient with ankylosing spondylitis. The patient was indicated for subtotal gastrectomy because of the aggravation of obstructive symptoms, but refused the operation and was transferred to another hospital. Three months later, the patient died of aspiration pneumonia during medical treatment.
고안된 Overtube를 이용하여 제거된 날카로운 식도이물 1예
류상열,김성환,선춘식,정미연,안상봉,손병관,조윤주,박영숙 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.5
Foreign bodies in the upper esophagus should be removed as soon as possible to avoid serious complications. These foreign bodies can penetrate the bowel wall and cause severe complications. The peristalsis of the esophagus is not strong enough to prevent it from retaining swallowed objects. Hence, perforation from a foreign body is more likely to occur in the esophagus than in the rest of the gastrointestinal tract. A razor blade is a rare foreign body of the esophagus. Its sharpness and large size make it difficult to remove. A razor blade was very firmly impacted in the esophageal wall in our case, and the razor blade had not moved from the upper esophagus. A standard overtube has limitations to remove a razor blade inside the overtube’s lumen. We report here on a case of using a wedge resected overtube made it possible to successfully extract a razor blade and no serious complications occurred after extraction of the razor blade. 식도의 예리한 이물은 내시경으로 제거하는 과정 중에도 출혈, 천공 등 심각한 합병증이 발생할 수 있다. 따라서 안전하게 제거하는 방법으로 지금까지 overtube, protector hood 등이 사용되어 왔다. 면도날은 흔하지 않은 식도 이물이지만, 크기가 크고 날카로운 날로 인해 제거하기가 쉽지 않다. 저자들은 일반적인 overtube의 내경보다 크고 식도에 매복된 면도날을 쐐기모양으로 고안한 overtube를 이용하여 안전하게 제거한 1예를 문헌 고찰과 함께 보고한다.
복막투석 환자에서 발생한 Delftia acidovorans 복막염 1예
송은주 ( Eun Ju Song ),선춘식 ( Choon Sik Seon ),박세환 ( Se Hwan Park ),정종관 ( Jong Kwan Jung ),이소영 ( So Young Lee ),성수아 ( Su Ah Sung ),황영환 ( Young Hwan Hwang ),조영욱 ( Young Uk Cho ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3
Delftia acidovarans is aerobic, nonfermentative Gram-negative rod commonly found in soil and water. Generally it is nonpathogenic but it unusually can cause bacteremia in immunocompromised patients. We present a case of peritonitis due to D. acidovorans in a patient on continuous ambulatory peritoneal dialysis. A 75-year-old woman was admitted with abdominal pain and cloudy peritoneal effluent. She was empirically treated with intraperitoneal (IP) cefazolin and ceftazidime, and then IP ceftazidime and oral ciprofloxacin, but peritonitis did not improve. Seven days after admission, D. acidovorans was identified from the peritoneal effluent, which was sensitive to amikacin, ceftazidime, ciprofloxacin and imipenem. Catheter removal was considered with regard to poor response to adequate antibiotics; however, 4 days after changing to IP imipenem/cilastatin, abdominal pain, the leukocyte count of peritoneal effluent and C-reactive protein decreased. She was treated with imipenem/cilastatin for two weeks and discharged with the dialysis catheter intact.
정상 폐활량을 보이는 성인 환자에서 $FEF_{25{\sim}75%}$를 통한 기관지확장제 반응의 예견
박세환,이승엽,강승모,선춘식,김현경,이병훈,이재형,김상훈,Park, Se-Hwan,Lee, Seung-Yup,Kang, Seung-Mo,Seon, Choon-Sik,Kim, Hyun-Kyung,Lee, Byoung-Hoon,Lee, Jae-Hyung,Kim, Sang-Hoon 대한결핵및호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.3
Background: When patients with chronic respiratory symptoms have a normal spirometry result, it is not always easy to consider bronchial asthma as the preferential diagnosis. Forced expiratory flow between 25% and 75% of vital capacity ($FEF_{25{\sim}75%}$) is known as a useful diagnostic value of small airway diseases. However, it is not commonly used, because of its high individual variability. We evaluated the pattern of bronchodilator responsiveness (BDR) and the correlation between $FEF_{25{\sim}75%}$ and BDR in patients with suspicious asthma and normal spirometry. Methods: Among patients with suspicious bronchial asthma, 440 adult patients with a normal spirometry result (forced expiratory volume in one second [$FEV_1$]/forced vital capacity [FVC] ${\geq}70%$ & $FEV_1%$ predicted ${\geq}80%$) were enrolled. We divided this group into a positive BDR group (n=43) and negative BDR group (n=397), based on the result of BDR. A comparison was carried out of spirometric parameters with % change of $FEV_1$ after bronchodilator (${\Delta}FEV_1%$). Results: Among the 440 patients with normal spirometry, $FEF_{25{\sim}75%}%$ predicted were negatively correlated with ${\Delta}FEV_1%$ (r=-0.22, p<0.01), and BDR was positive in 43 patients (9.78%). The means of $FEF_{25{\sim}75%}%$ predicted were $64.0{\pm}14.5%$ in the BDR (+) group and $72.9{\pm}20.8%$ in the BDR (-) group (p<0.01). The negative correlation between $FEF_{25{\sim}75%}%$ predicted and ${\Delta}FEV_1%$ was stronger in the BDR (+) group (r=-0.38, p=0.01) than in the BDR (-) group (r=-0.17, p<0.01). In the ROC curve analysis, $FEF_{25{\sim}75%}$ at 75% of predicted value had 88.3% sensitivity and 40.3% specificity for detecting a positive BDR. Conclusion: BDR (+) was not rare in patients with suspicious asthma and normal spirometry. In these patients, $FEF_{25{\sim}75%}%$ predicted was well correlated with BDR.
정상 폐활량을 보이는 성인 환자에서 FEF25~75%를 통한 기관지확장제 반응의 예견
박세환 ( Se Hwan Park ),이승엽 ( Seung Yup Lee ),강승모 ( Seung Mo Kang ),선춘식 ( Choon Sik Seon ),김현경 ( Hyun Kyung Kim ),이병훈 ( Byoung Hoon Lee ),이재형 ( Jae Hyung Lee ),김상훈 ( Sang Hoon Kim ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.3
Background: When patients with chronic respiratory symptoms have a normal spirometry result, it is not always easy to consider bronchial asthma as the preferential diagnosis. Forced expiratory flow between 25% and 75% of vital capacity (FEF25~75%) is known as a useful diagnostic value of small airway diseases. However, it is not commonly used, because of its high individual variability. We evaluated the pattern of bronchodilator responsiveness (BDR) and the correlation between FEF25~75% and BDR in patients with suspicious asthma and normal spirometry. Methods: Among patients with suspicious bronchial asthma, 440 adult patients with a normal spirometry result (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] ≥70% & FEV1% predicted ≥80%) were enrolled. We divided this group into a positive BDR group (n=43) and negative BDR group (n=397), based on the result of BDR. A comparison was carried out of spirometric parameters with % change of FEV1 after bronchodilator (ΔFEV1%). Results: Among the 440 patients with normal spirometry, FEF25~75%% predicted were negatively correlated with ΔFEV1% (r=?0.22, p<0.01), and BDR was positive in 43 patients (9.78%). The means of FEF25~75%% predicted were 64.0±14.5% in the BDR (+) group and 72.9±20.8% in the BDR (?) group (p<0.01). The negative correlation between FEF25~75%% predicted and ΔFEV1% was stronger in the BDR (+) group (r=?0.38, p=0.01) than in the BDR (?) group (r=?0.17, p<0.01). In the ROC curve analysis, FEF25~75% at 75% of predicted value had 88.3% sensitivity and 40.3% specificity for detecting a positive BDR. Conclusion: BDR (+) was not rare in patients with suspicious asthma and normal spirometry. In these patients, FEF25~75%% predicted was well correlated with BDR.