갑상선 중독성 저칼륨혈증성 주기성 마비의 임상상

이순구 ( Lee Sun Gu ),김성숙 ( Kim Seong Sug ),정민수 ( Jeong Min Su ),송치운 ( Song Chi Un ),윤상임 ( Yun Sang Im ),성기양 ( Seong Gi Yang ),이강욱 ( Lee Gang Ug ),신영태 ( Sin Yeong Tae ),노흥규 ( No Heung Gyu ) 대한내과학회 1993 대한내과학회지 Vol.44 No.1

연구배경 : 갑상선중독성 저칼륨혈증성 주기성 마비는 갑상선항진중에서 양측성으로 주로 하지에 국한되는 이완성 마비로 현저한 저칼륨혈증을 동반하는 질환으로 젊은 동양인 남자에서 호발한다고 알려져 있다. 방법 : 저자들은 본 질환의 임상적 특징을 알아보고자 충남대학교 병원에 내원하였던 9명의 갑상선중독성 저칼륨혈증성 주기성 마비환자들을 대상으로 각종 임상적 소견들을 분석하였다. 결과 : 1) 대상환자는 9명 모두 남자였으며, 평균연령은 31.3±5.9(23~42)에 였다. 주기성 마비의 가족력은 없었다. 2) 마비 발작시 혈청 칼륨치는 평균 1.82±0.25(1.49~2.33)mmol/L로 현저히 감소되어 있었다. 3) 마비는 주로 늦은밤과 이른 새벽에 발생하였고, 계절적 차이는 없었다. 4) 유발 요인으로는 심한 운동, 과식, 과음, 감염 등 이었다. 5) 갑상선 중독성 저칼륨혈증성 주기성 마비는 칼륨이온 투여와 항갑상선선제 투여로 재발없이 치료되었다. 결론 : 주기성 마비가 동반된 갑상선중독증의 젊은 남자 환자에서 심한 저칼륨혈증 및 각종 유발인자들에 대한 주의가 필요한 것으로 생각되었다. Background : Thyrotoxic hypokalemic periodic paralysis is a well recognized complication of hyperthyroidism in mainly Oriental men, and in association with hypokalemia and flaccid type paralysis of legs. Method : Nine patients with thyrotoxic hypokalemic periodic paralysis hve been studied retrospectively by the authors at the Chungnam National University Hospital from Jan 1989 to Mar 1992 for the evaluation of clinical characteristics. Results : 1) All patients were males aged 31.3±5.9 (range 23~42) years old. 2) The average serum potassium level during paralysis was 1.82±0.25 (range 1.49~2.33) mmol/L. 3) Attacks of paralysis occurred at night and early morning. 4) The precipitating factors were severe exercise, overeating, alcohol drinking, and infection. 5) The attacks of paralysis usually disappeared after effective treatment with potassium salt and antithyroid drug. Conclusion : We thought that meticulous attention should be paid for hypokalemia and thyrotoxicosis in young patients with history of periodic paralysis.

그레이브스병 환자의 갑상선 조직에서 Intercellular Adhesion Molecule - 1 ( ICAM - 1 ) 및 Heat Shock Protein -70 ( HSP - 70 ) 의 발현에 대한 연구

이강현(Kang Hyun Lee),안봉수(Bong Soo An),이진홍(Jin Hong Lee),안미애(Mee Ae Ahn),송치운(Chi Un Song),송민호(Min Ho Shong),노홍규(Heung Kyu Ro) 대한내과학회 1996 대한내과학회지 Vol.50 No.2

N/A causing Graves` disease and the soluble form of ICAM-1 are markedly elevated in the sera from patients with Graves` disease

부신 결핵에 의한 Addison씨병 1예

송치운,구본정,안봉수,전준식,안미애,이진홍,송민호,김영건,노흥규 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

Addison's disease is a rare primary adrenal insufficient disorder resulting from chronic deficiency of adrenal cortical hormones. Clinical manefestations are generalized weakenss, weight loss, hyperpigmentation (especially sun exposed area and mucous membrane), hypotension, hyponatremia, hyperkalemia, gastrointestinal symptoms (involving anorexia, nausea, vomiting, abdominal pain). A 34-year-old woman has experienced slowly progressive generalized weakenss and skin pigmentation, anorexia, nausea, vomiting with ascites and diffuse abdominal pain. On the time of admission, her main clinical manifestations were anorexia, nausea, vomiting, fatigue, generalized weakness, amenorrhea, hair loss, diffuse abdominal pain revealed as Addison's disease due to bilateral adrenal tuberculosis. Her adrenal insufficient symptoms were recovered with the replacement of adrenocortical hormones and antituberculous medications. After treatment, Her skin pigmentation was decreased and menstruation was reappeared. Here we experienced one cases of Addison's disease with tuberculous peritonitis.

혈액투석중인 만성신부전 환자에서 골대사 지표로써의 Osteocalcin치

송치운,이진홍,안미애,윤환중,윤상임,성기양,이강현,송민호,이강욱,신영태,김영건,노흥규 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Background : Serum osteocalcin is synthesized by osteoblast and has been shown to be sensitive indicator of bone turnover inpatients with various metabolic bone disease. In renal osteodystrophy, serum osteocalcin is elevated due to decreased renal clearance and elevated level of PTH. This study was done to evaluate the usefulness of serum osteocalcin as a marker of bone metabolism and the correlation with other biochemical markers of bone metabolism. Methods : We measured serum osteocalcin, calcium, phosphorus, ALP(alkaline phosphatase) and PTH(parathyroid hormone) in 37 patients with end stage renal disease on hemodialysis. Osteocalcin was determined by radioimmunoassay and PTH was determined by radioimmunometric assay. Results : 1) The mean level of serum osteocalcin in ESRD patients was 233.8± 218.2ng/ml which was significantly higher than that of controls(p<0.0001). 2) The mean level of serum PTH in ESRD patients was 40.5± 43.8pg/ml was significantly higher than that of controls(p<0.005). 3) There was a significant positive correlation between the level of serum PTH, ALP and the level of serum osteocalcin in ESRD patients. 4) By using multiple regression, PTH is most reliable factor that affect to elevated level of serum osteocalcin ( beta coefficient = 0.687, Sig T<0.05). Conclusion : Serum osteocalcin as a marker of bone metabolism in ESRD patients is more useful than other biochemical marker such as serum calcium, phosphorus, ALP and PTH is a most reliable factor that affect to elevated level of serum osteocalin.

산후 갑상선염의 경과에 관한 임상적 고찰

노흥규,송치운,송민호 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

Postpartum thyroiditis is a disease with transient changes of thyroid function as hyperthyroidism, hypothyroidism and normal recovery 2-4 months after delivery. It occurs in 7-9% of postpartum women, is needed careful differential diagnosis from Graves' disease or Hashimoto's thyroiditis because of quite different clinical course. In order to establish the points for differentiation, we evaluated 30 cases of postpartum thyroiditis patients with the following results. 1. 14 patients were diagnosed as hyperthyroidism 4.4±1.6 months after delivery with mild degree of thyrotoxic symptoms. The anti-thyroglobulin antibody and anti-microsomal antibody were positive but thyrotropin receptor antibody were negative. 2. 16 cases were diagnosed as hypothyroidism with enlarged goiter 6.1±0.9 months after delivery and the ATA and AMA were positive both but TBII was negative in all cases. 3. The thyroid function of 71.4% of hyperthyroid patients became hypothyroidism in 1-3 months and recovered to normal in 1-3.5 months thereafter. In 68.8% of hypothyroid patients became euthyroidism within 1-8 months and 21.4% 1(3 cases) of the patients remained as hypothroidism untill 12 months' observation. In conclusion, the thyroid function changes as hyperthyroidism, hypothyroidism and euthyroidism stepwise in most cases of pospartum thyroiditis and serum TBII is negative, which are the most important features in differentiating from other autoimmune thyroid disease.

폐경기후 골다공증의 약물요법

노흥규,송치운,이진홍,안미애,송민호 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Postmenopausal osteoporosis is an enormous public health problem. Estrogens, and various drugs were developed and used for prevention and treatment of postmenopausal bone loss. In this study, We evaluated the effects of cycloprogynova, cyclofenil and ipriflavone on postmenopausal bone loss. Fourty post menopausal women were divided into 3 groups by treatment modalities Cyclofenil group (groupl), Cycloprogynova group(group 2) and Ipriflavone group(group 3). Basal bone mineral densities in all subjects were determined by DEXA(Dual Energy X-ray Absorptiometry) and those were compared with bone mineral densities after medication. The durations of medication in all groups were showed no statistical difference, group 1 11.4 ± 3.4 months, group 2 10.6 ± 3.9 months, group 3 12.9 ± 3.4 months. The patients of group 2 showed significant increase in bone mineral densities and the patients of group 1 and group 3 revealed no significant bone loss on paired T-test. Comparing with rates of bone loss in normal Korean postmenopausal women, the rates of bone loss in all subjects were effectively retarded. The significant bone loss (above longterm intertest coeffcient of variation) was noted in 8 patients out of 23 subjects in group 1, in 9 patietns out of 11 subjects in group 2 and in 2 patients out of 6 subjects in group 3. In conclusion, estrogen/progesteron(Cycloprogynova) replacemnt therapy showed most prominent bone preserving effect and Cyclofenil and Ipriflavone also effectively delays shorterm bone loss in postmenopausal women.

갑상선 질환 환자에서 골밀도와 혈청 Osteocalcin 농도의 분석

노흥규,송치운,윤상임,성기양,송민호 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

Spontaneous hyperthyroidism and that due to excessive administration of thyroid hormone result in osteopenia. However there has been no general agreement on the incidence of osteopenia in hyperthyroidism or the recovery of the mineral loss after treatment of hyperthyroidism or the recovery of the mineral loss after treatment of hyperthyroidism. We conducted a cross sectional study on the effect of hyperthyroidism and its treatment on vertebral bone mineral density using dual energy x-ray absorptiometry. We measured vertebral bone mineral density, serum Gla protein and serum intact PTH in 21 postmenopausal Graves' patients who maintained euthyroid state with antithyroid drug treatment and in 10 patients with nontoxic nodular goiter that received no suppressive thyroid hormone. Bone mineral densities of lumbar spine in patients with Graves' disease showed no significant decrease compared to patients with nontoxic nodular goiter. The level of serum Gla protein in patients with Graves' disease was significantly higher than that of patients with nodular nontoxic goiter and it was positvely correlated with serum T_3level. The level of serum intact PTH showed no significant difference between both groups of patients with Graves' disease and nodular nontoxic goiter. The serum levels of Gla protein were positively correlated with the values of serum PTH in all patients with Graves' disease and nodular nontoxic goiter. The bone mineral densities of the postmenopausal patients with Graves' disease following induction of euthyroid state with antithyroid drug treatment showed no significant decrease compared to controls.

급만성 간질환에 대한 Arginine Thiazolidine Carboxylate (ALPIL^(�))의 치료효과

노홍규,허승식,송치운,이헌영 최신의학사 1993 最新醫學 Vol.36 No.10

자가면역성 다선 증후군 : 그레이브스병에 동반된 악성 빈혈 및 인슐린 의존형 당뇨병 1 예

김영건,김삼용,송민호,노흥규,송치운,윤상임,김성숙,성기양 대한내분비학회 1993 Endocrinology and metabolism Vol.8 No.2

The organ specific autoimmune diseases may occur in the same individual. Polyglandular autoimmune syndrome designates the dysfunction of endocrine and nonendocrine system involving two or more oragans on the basis of autoimmunity. This syndrome is usually classified into three classes. Type III polyglandular autoimmune syndrome is defined by the occurrence in the same individual of two or more of the followings: autoimmune thyroid disease, pernicilus anemia, insulin dependent diabetes, and other organ specific autoimmune disease not falling into class I or class II categories. A 29-year-old man developed pernicious anemia and insulin dependent diabetes during the treatment of Graves' disease with antithyroid drug(propylthiouracil). He developed a spontaneous pancytopenia during the course of Graves' disease that showed euthyroid state with antithyroid drug,propylthiouracil. Bone marrow and peripheral blood revealed the findings compatible with megaloblastic anemia. The blood level of vitamin B12 was low and the serum titers of antibodies to gastric parietal cell and intrinsic factor was high. About two years after the treatment of pernicious anemia, he developed insulin dependent diabetes mellitus. The ICSA (islet cell surface antibody)and ICA (islet cell antibody)were negative. His HLA serotype was A24, A11, Bw60, B51, Cw3, DRw15, DRw17. We report here a case of polyglandular autoimmune syndrome, type III manifesting Graves' disease,pernicilus anemia, and insulin dependent diabetes mellitus.(J Kor Soc Endocrinol 8:211-215, 1993)

당뇨병에 합병한 고지혈증에 대한 Acipimox(Olbetam)의 효과

김영건,김진희,전준식,송치운,송민호 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Multiple abnormalities of lipoprotein metabolism exist in patients with diabetes mellitus that could contribute to their enhanced susceptibility to atherosclerosis. Acipimox(5-methyl-pyrazine carboxylic acid 4-oxide, Farmitala Carlo Erba, Milano Italy) is a new potent and long acting(8h) antilipolytic agent, which has been derived from nicotinic acid. By lowering plasma and possibly skeletal muscle concentrations of non-esterified fatty acid, Acipimox may have a potential beneficial effect on glucose metabolism in patients with non-insulin dependent diabetes mellitus. The aim of this study was to evaluate the acute effect of Acipimox on hyperlipidemia associated with non-insulin dependent diabetes mellitus. 18 patients with non-insulin dependent diabetes mellitus were in the study. They had fasting plasma triglyceride concentrations above 250 mg/dl and cholesterol concentrations above 240 mg/dl. The level of triglyceride, cholesterol and glycated hemoglobin were significantly reduced after 8 weeks treatment of Acipimox. Adverse effects were noted in 3 patients, but it was transient with the course of administration. Acipimox is an effective and safe drug for the management of hyperlipidemia associated with non-insulin dependent diabetes mellitus.