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당뇨병성 신경병증 진단법의 유용성 ( 예비보고 ) - Feldman 등의 2 단계 진단법에 대하여 -
신영구(Young Goo Shin),오윤정(Yoon Jung Oh),고영윤(Young Yoon Ko),이성근(Seong Keun Lee),이성규(Seong Kyu Lee),정윤석(Yoon Sok Jung),이관우(Kawn Woo Lee),김현만(Hyeon Man Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.6
N/A Objectives: It is important to consider the symptoms of diabetic neuropathy in determining a diagnostic approach. To evaluate diabetic neuropathy, an appropriate questionnaire for Korean diabetic patients is required. In 1994, Feldman et al. proposed the two-step diagnostic approach which included a questionnaire. To adapt a diagnostic approach and questionnaire for Korean diabetics, we initially diagnosed diabetic neuropathy by using Feldman's method and by assessing the efficiency of their method for Korean diabetics as a preliminary study. Methods: We diagnosed diabetic neuropathy with Feldman's method in 99 NlDDM patients who visited Ajou university hospital from October 1, 1996 to April 30, 1997. The sensitivity and specificity of Feldman's diagnostic procedures were ebaluated. To include the highly specific symptoms in the diagnostic approach, we applied a different scaring system (from 5 to 1) to the questionnaire accroding to specificity and then evaluated the sensitivity and specificity with this new system. If the sensitivity and specificity were 60% or more, the new scoring system was regarded as clinically useful. Results: Using Feldman's method, the sensitivity of MNSIQ and MNSIC was 12.8% and the specificity was 88.3% and 98.3%, respectively. The sensitivity of MDNS and NCV was 100% and the specificity was 68.3% and 61.6%, respectively. The new scoring system consisted of 13 of 15 questions with sensitivity of 46.2% and specificity of 71.7%, omitting 2 questions due to possible relation to vascular symptoms. Among the 4 diagnostic procedures, the strongest correlation existed between MDNS and NCV. None of the procedures had a significant correlation with MNSIQ. MNSIC, which shares similar characteristics with MDNS, had significant correlation with MDNS and NCV, but its sensitivity was very low. Conclusion: MNSIQ and MNSIC were not useful as screening instruments in the dignostic approach to diabetic neuropathy using Feldman's method, Thus, a new questionnaire composed of symptoms common in Korean diabetic patients should be designed, and MNSIC could be omitted from the diagnostic approach.
인슐린 비의존형 당뇨병 환자에서의 당뇨병 유병기간에 의한 미세혈관 합병증 발생 시기의 추정
원영준(Young Jun Won),신영구(Young Goo Shin),심광용(Kwang Yong Shim),홍애라(Ae La Hong),송창호(Chang Ho Song),정춘희(Choon Hee Chung),서병기(Byeong Ki Seo) 대한내과학회 1996 대한내과학회지 Vol.51 No.4
N/A Objectives: Microvascular complications in NID-DM patients have a positive correlation with the duration of diabetes. However, it is difficult to know about the duration of diabetic period before clinical diagnosis that the microvascular complications have been progressed, Harris et al previously presented in Diabetes Care that the patients with NIDDM had the prediagnostic period of 4-7 years before clinical diagnosis. We can find frequently the microvascular complications at the time of clinical diagnosis of diabetes, and thus assume that the microvascular complications have developed before the clinical diagnosis of diabetes. We estimate the periods, between the onset of diabetes and its clinical diagnosis in Korean diabetic patients. Methods - We studied 281 NIDDM patients who were admitted at Wonju Christian Hospital from January 1993 to July 1994. Weighted linear regression was performed to examine the relationship between the duration of diabetes and the prevalence of microvascular complications of diabetes. We can find the linear relationship between the two parameters (prevalence and duration of diabetes). By extraplotting at this linear relationship to the time when the prevalence of microvaseular complication was estimated to be zero, the time of onset of detectable complication was calculated. Results: 1) Prevalence of neuropathy at clinical diagnosis of diabetes was estimated to be 35.9%, and neuropathy has occurred 10.6 years before the clinical diagnosis of NIDDM. 2) Prevalencd of retinopathy at clinical diagnosis of diabetes was estimated to be 21.6%, and retinopathy has occurred 6.4 years before the clinical diagnosis of NIDDM. 3) In the cases of nephropathy, the correlation between the duration of diabetes and the prevalence was not statistically significant. Conclusion: In our study, the microvascular complications may develop several years before the clinical diagnosis of diabetes, and therefore, checkup for the microvascular complications is essential at the diagnosis of diabetes.
증례 : 내분비-대사 ; Dyke-Davidoff-Masson 증후군 환자에서 발생한 뇌하수체 기능저하증과 당뇨병 1예
박소연 ( So Yeon Park ),이미영 ( Mi Young Lee ),김재현 ( Jae Hyun Kim ),김송이 ( Song Yi Kim ),신장열 ( Jang Yel Shin ),신영구 ( Young Goo Shin ),정춘희 ( Choon Hee Chung ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3
저자들은 생후 일찍 경련이 발생하여 부전마비 임상적 소견, 방사선학적 검사 및 유전학적 검사를 통해 Dyke-Davidoff-Masson 증후군이 진단된 환자에서 뇌하수체 기능저하증 및 당뇨병이 동반된 사례를 경험하였기에 보고하는 바이다. Dyke-Davidoff-Masson syndrome (DDMS) is a rare condition characterized by asymmetric cerebral hemispheric growth with unilateral atrophy, ipsilateral compensatory osseous hypertrophy, hyperpneumatization of the paranasal sinuses and mastoid cells, and contralateral paresis. Varying degrees of hemiparesis, hemiplegia, seizures, mental retardation, and facial asymmetry can be associated with DDMS. We report the case of a 26-year-old man with DDMS associated with hypopituitarism who complained of polydipsia and polyuria. After an oral glucose tolerance test, he was diagnosed with type 2 diabetes. There is no report of DDMS associated with other pituitary dysfunction or hyperglycemia. Clinicians should consider the possibility of coexisting pituitary dysfunction or type 2 diabetes in patients with DDMS, as it is obviously important for the patient`s outcome. (Korean J Med 79:316-320, 2010)
송창호(Chang Ho Song),원영준(Young Jun Won),류정선(Jeong Seon Ryu),신영구(Young Goo Shin),정춘희(Choon Hee Chung),최동훈(Dong Hoon Choi),송영득(Young Duk Song),남문석(Moon Suk Nam),이지현(Ji Hyun Lee),이은직(Eun Jig Lee),임승길(Sung 대한내과학회 1996 대한내과학회지 Vol.51 No.2
N/A Objectives : With increasing the incidence and prevalence of elderly diabetics, there were many reports of elderly diabetics in Korea. But there were few reports of elderly diabetics who were diagnosed at old age. The aim of this study was to elucidate the clinical characteristics of elderly diabetics diagnosed after 60 years old. Methods: On the basis of age when they were diagnosed at first, elderly diabetics(N=105) were more than 60 years old and adult diabetics were 40-59 years old. Some characteristic symptoms, laboratory findings, associated diseases, complications and treatment modalities of elderly diabetics were compared with those of adult diabetics. Results: 1) The prevalences of characteristic symptoms such as polydipsia, polyphagia and polyuria in elderly diabetics were much higher than those of adult diabetics. 2) Hypertension, coronary artery disease, malignancy and gall stone were more frequently associated in elderly diabetics than those in adult diabetics, but fatty liver was more frequent in adult diabetics. 3) The prevalences of diabetic retinopathy and nephropathy in elderly diabetics were similar to those of adult diabetics, but the prevalence of diabetic neuropathy in elderly diabetics was lower than those in adult diabetics, 4) Treatment modalities of elderly diabetics were oral hypoglycemic agents, diet and exercise, and insulin in order at discharge from hospital, and the use of diet and exercise was more frequent in elderly diabetics than in adult diabetics. Conclusion: Some clinical characteristics of elderly diabetics were different from those of adult diabetics. We suggest that these findings should be considered at diagnosis and treatment of Elderly diabetics.
증례 : 내분비-대사 ; 융모 상피성 종양을 진단받은 환자에서 발병한 갑상선 유두암 1예
김재현 ( Jae Hyun Kim ),김송이 ( Song Yi Kim ),이미영 ( Mi Young Lee ),신장열 ( Jang Yel Shin ),신영구 ( Young Goo Shin ),정춘희 ( Choon Hee Chung ) 대한내과학회 2011 대한내과학회지 Vol.80 No.4
갑상선 암은 가장 흔한 내분비암 중 하나이다. 갑상선은 성호르몬과 β-HCG 등의 영향을 받기 때문에 β-HCG가 증가되는 임신시나 융모 상피성 질환에서 갑상선 질환의 발생이 촉진 될 수 있다고 알려져 왔다. 하지만 융모 상피성 종양 환자에서 갑상선 암이 동반된 경우는 아직까지 국내에서 보고되지 않았다. 이에 저자는 융모 상피성 종양 환자에서 갑상선 유두암이 동반된 사례를 경험하였기에 문헌고찰과 함께 보고한다. Thyroid cancer is one of the most common endocrine malignancies. It is known that thyroid cancer can develop during reproductive periods, possibly due to the effects of sex hormones and growth factors such human chorionic gonadotrophin (HCG). Some data suggest that elevated HCG levels during pregnancy or gestational trophoblastic disease can stimulate thyroid cellular proliferation and promote cancer formation; however, a case of papillary thyroid cancer accompanied by a gestational trophoblastic tumor has not been reported. Here, we report the case of a 44-year-old woman with papillary thyroid cancer during treatment for a gestational trophoblastic tumor. (Korean J Med 2011;80:464-468)
조기원 ( Ki Won Jo ),고장현 ( Jang Hyun Koh ),이미영 ( Mi Young Lee ),정필문 ( Feel Moon Jung ),신영구 ( Young Goo Shin ),용석중 ( Suk Joong Yong ),정춘희 ( Choon Hee Chung ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.5
Sarcoidosis is a multisystemic granulomatous disease with an of unknown etiology, involving bilateral hilar lymphadenopathy, pulmonary, skin and eye lesions. However, involvement of the endocrine system in sarcoidosis is quite rare, and the coexistence of both diseases is extremely unusual. We describe a 60-year-old woman presenting with sarcoidosis and Graves` disease. She was admitted for evaluation of dry cough, dyspnea, palpitation and general weakness. Both thyroid glands were enlarged diffusely. The thyroid function tests showed suppressed serum thyrotropin and an increased thyroid hormone level. The levels of the TSH receptor antibody, anti-thyroglobulin antibody and anti-microsomal antibody were higher than normal. The radionuclide scan(131I) showed increased iodine uptake. The chest X-ray revealed pulmonary hilar enlargement and high resolution CT showed both hilar lymph nodes enlargement and tiny parenchymal nodules. The transbronchial lung biopsy showed a noncaseating granuloma without necrosis. We report this case of pulmonary sarcoidosis plus Graves` disease with a review of the relevant literatures. (Tuberc Respir Dis 2007; 62: 417-420)
IPSS 검사로 진단된 TSH 분비 뇌하수체 미세선종 1예
성중경 ( Joong Kyung Sung ),김은미 ( Eun Mi Kim ),남수민 ( Su Min Nam ),신영구 ( Young Goo Shin ),정춘희 ( Choon Hee Chung ),황금 ( Kum Whang ),고장현 ( Jang Hyun Koh ) 대한내과학회 2009 대한내과학회지 Vol.76 No.6
갑상선자극호르몬 분비 뇌하수체 선종은 전체 뇌하수체선종의 1~2%에 해당하는 드문 질환이다. 그 중에서도 뇌하수체 미세선종은 호르몬 분비량이 적기 때문에 말초 정맥에서 측정한 알파 소단위가 정상을 나타내는 경우가 많다. 저자들은 이러한 환자에서 아래바위정맥동굴에서 갑상선자극호르몬유리호르몬 자극 검사를 시행하여 말초혈액과의 차이를 통해 뇌하수체 미세선종의 진단에 효과적으로 사용한 증례를 경험하였기에 문헌고찰과 함께 보고한다. Thyroid stimulating hormone (TSH)-secreting pituitary adenomas are rare tumors of the pituitary gland and represent 1~2% of all pituitary adenomas. A TSH-secreting pituitary adenoma shows as a normal or elevated thyrotropin level in a hyperthyroid patient. We present a 32-year-old woman who was diagnosed with a TSH-secreting pituitary microadenoma. She had a high free T4, with a normal TSH and α-subunit. Bilateral inferior petrosal sinus sampling (IPSS) was done to confirm the α-subunit secreting adenoma, and the concentration of the α-subunit was high on the tumor side. The pituitary microadenoma was removed, and her TSH and free T4 levels decreased to normal. IPSS may help give an accurate diagnosis in the patient with a normal α-subunit. (Korean J Med 76:752-757, 2009)
증례 : 순환기 ; 좌심실 혈전증이 합병된 스트레스 유발성 심근증 1예
한상우 ( Sang Woo Han ),이요한 ( Yo Han Lee ),이준원 ( Jun Won Lee ),김장영 ( Jang Young Kim ),신영구 ( Young Goo Shin ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S
대부분의 스트레스 유발성 심근증 환자는 양호한 경과를 보이나. 드물게 심첨부 혈전증이 동반할 수 있다. 저자들은 스트레스 유발성 심근증에서 좌심실 혈전증에 의한 다발성 혈전색전증이 확인된 예를 경험하여 이를 보고하는 바이다. Left ventricular thrombosis is a rare complication of stress-induced cardiomyopathy. Transient left ventricular dysfunction and apical ballooning may precipitate an apical thrombus in the left ventricle. Here we report the case of a 46-year-old female who was diagnosed with stress-induced cardiomyopathy complicated by multiple thromboembolisms originating from an apical thrombus of the left ventricle. (Korean J Med 77:S1166-S1169, 2009)