대망에서 발견된 성숙 기형종

조출현 ( Chool Hyun Cho ),조윤영 ( Yoon Young Cho ),김진 ( Jin Kim ),유석동 ( Seok Dong Yoo ),인태효 ( Tae Hyo In ),박종배 ( Jong Bae Park ),강행지 ( Haeng Ji Kang ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.7

The mature cystic teratoma of the omentum is a very rare tumor. It is generally believed that autoamputation and reimplantation of an ovarian tumor is the most common etiology of omental teratoma. Abdominal pain is the main presenting symptom of these tumors. A 41-year-old woman was admitted for pelvic mass. At laparotomy, a 8.5×7.0×7.5㎝ mass was found in the pelvic cavity, attached to the omentum with adhesion to bladder. The histopathologic diagnosis was mature cystic teratoma in conjunction with the cyst wall is diffusely necrotic and calcified with hairs. The absence of the left ovary suggested that the tumor underwent autoamputation and reimplantation on the omentum. We report the case with a brief review of literature.

모녀간 골밀도에 미치는 유전적, 환경적 인자의 영향

이창원 ( Chang Won Lee ),박근용 ( Keun Yong Park ),이영실 ( Young Sil Lee ),유석동 ( Seok Dong Yoo ),안준협 ( Jun Hyeop An ),공옥녀 ( Ok Nyu Kong ),손석민 ( Seok Man Son ),김인주 ( In Ju Kim ),김용기 ( Yong Ki Kim ) 대한폐경학회 2003 대한폐경학회지 Vol.9 No.3

연구의 목적 : 골밀도는 주로 유전적 인자에 의해 결정된다고 알려져 있다. 외국의 여러 쌍생아 및 가계 연구에서 골밀도에 미치는 유전적 인자의 영향력은 약 50-85%로 알려져 있다. 그러나 한국인에서 골밀도에 미치는 유전적인자의 영향력의 크기는 잘 알려져 있지 않다. 이에 저자들은 20대 젊은 여성과 그들 어머니를 대상으로 하여 골밀도에 미치는 유전적 소인과 환경적 인자의 영향력을 확인하고자 하였다. 연구재료 및 방법 : 건강한 평균 나이 20±1.2세의 여대생 95명과 평균 나이 45±2.7세의 폐경이 되지 않은 그들의 어머니를 대상으로 하였으며 이중에너지 흡수계측기(DXA, Hologic QDR 4500 A.)를 이용하여 요골원위부, 제 2-4 요추 및 대퇴골의 골밀도를 측정하였다. 대상자들은 설문지를 통해 흡연력, 음주력, 월경력, 신장, 체중, 체질량짓, 반정량적인 칼슘 섭취량과 및 일일 총열량 소모량을 얻었다. 모녀간 골밀도의 상관관계를 구하기 위해 골밀도에 영향을 주는 인자들인 나이, 신체 계측치 및 환경적 인자들을 선형 회귀 분석을 통하여 보정하였다. 결과 및 결론 : 나이와 키, 몸무게를 보정하였을 때 어머니의 Z-score와 딸의 골밀도와의 상관계수는 0.242에서 0.278 사이였으며 칼슘섭취량과 육체적 활동량까지 보정하였을 때 상관계수는 0.234에서 0.289 사이였다. 이 수치는 딸의 골밀도에 미치는 어머니와 아버지의 유전적 영향력이 동일하다는 가정 하에 유전적인 영향력의 크기가 46-58%임을 시사한다. 결론적으로 최대골량은 유전적 인자에 의해 주로 결정된다는 사실을 알 수 있었으며 유전적 인자의 영향력을 제외한 부분이 환경적 인자와 같은 비유전적인 요소의 영향력이라 가정한다면 골밀도에 미치는 환경적 인자의 영향력도 중요할 것으로 생각된다. Objectives: It is well known that genetic factors play major role in the regulation of bone mineral density(BMD). The heritability of BMD has been estimated to lie between 50% and 85% in twin studies. Family-based studies have also yielded strong heritability estimates for BMD. But heritability of BMD in Korean people has not been well estimated. So we evaluated the influences of heredity and environmental factors on BMD in Korean mother-daughter pairs. Method : BMD of the lumbar, femur and wrist was measured in 95 healthy Korean mother-daughter pairs by dual-energy absorptiometry. Mothers and daughters were aged 20+ 1.2 and 45±2.7 years, respectively. Similarities in selected life-style factors thought to influence BMD, such as physical activity, calcium intake were also evaluated. Result : Correlation coefficients between the mother Z score and daughter BMD ranged from 0.28 to 0.31. Adjustm ent of bone density for age, height, weight, and life-style factors yielded heritability estimates for the three skeletal sites between 0.23 and 0.29. This would be equivalent to 46-58% heritability from both parents if there are similar contributions from both parents Conclusion : These observations provide support for a significant contribution of heridity to bone density. (However, magnitude of estimates derived from this study were lower as compared with other studies.) Also an individual`s life-style may account for a potentially large proportion of the non-heritable variance in bone density.

활동성 폐결핵의 판정에서 99mTc-MIBI 의 유용성

김용기(Yong Ki Kim),김인주(In Ju Kim),이효진(Hyo Jin Lee),전두수(Doo Soo Cheon),유석동(Seok Dong Yoo),이민기(Min Ki Lee),박순규(Soon Kew Park),김성장(Seong Jang Kim) 대한핵의학회 1998 핵의학 분자영상 Vol.32 No.1

N/A The use of radiopharmaceuticals in evaluation of pulmonary tuberculosis may help to resolve difficult diagnostic problems such as discordance between sputum examinations and chest roentgenographic findings. We investigated the usefulness of 99mTc-methoxyisobutylisonitrile(MIBI) scintigraphy in the detection of active pulmonary tuberculosis. Forty-six patients with suspected active pulmonary tuberculosis were studied with sputum smear of AFB, sputum AFB culture, chest X-ray and MIBI scan. MIBI image was obtained 15 and 60 min after intravenous injection of 370MBq(10mCi) 99mTc-MIBI. In 16 patients of them Ga scans were performed in addition to MIBI scan. Repeated MIBI scans were done in 7 patients with active pulmonary tuberculosis after 4∼6 months of antituberculous chemotherapy. Thirty-two patients were confirmed as active tuberculosis by sputum culture. Sensitivity of MIBI scan to active tuberculosis was 87.5%(28/32) and MIBI findings were negative in all of 14 patients with inactive disease. Focal uptake of MIBI was dense in the area that was strongly suggested active tuberculous lesions by chest roentgenogram. There was no discordance between MIBI and Ga image in 16 patients. But the uptake areas of Ga images were broader than that of MIBI images. After 4∼6 months of antituberculous treatment all repeated MIBI scans revealed negative findings except 1 patient with persistent active pulmonary tuberculosis due to drug resistance. MIBI scan could be used in the detection of active pulmonary tuberculosis as a useful noninvasive diagnostic tool.

당뇨병성 미세혈관 합병증 및 신경병증 환자에서 혈청 Lipoprotein ( a ) 의 농도

이경인(Kyoung In Lee),정준훈(Joon Hoon Jeong),최영근(Young Keun Choi),김영민(Young Min Kim),강양호(Yang Ho Kang),손석만(Seok Man Son),김윤성(Yun Seong Kim),김사웅(Sa Woong Kim),유석동(Seok Dong Yoo),김인주(In Joo Kim),김용기(Yong Ki 대한내과학회 1998 대한내과학회지 Vol.54 No.2

N/A Background: Several epidemiological studies have shown that high plasma concentration of lipoprotein(a) [Lp(a)] is associated with an increased risk for atherosclerotic cardiovascular disease and works as an independent risk factor for atherosclerosis. But, the significance of Lp(a) in diabetic microangiopathy & neuropathy is unclear essentially due to a paucity of relevant studies. This study was designed to evaluate whether Lp(a) concentration may be increased in patients with diabetic microangiopathy & neuropathy. Methods : We studied 96 patients who visited the department of internal medicine in Pusan National University Hospital from May 1995 to May 1996. The patients were grouped according to the presence of diabetic complications(microangiopathy and neuropathy, microangiopathy included retinopathy and nephropathy) and therapeutic modalities(diet, insulin, insulin with oral hypoglycemic agent, and oral hypoglycemic agent). Results: 1) Concentration of Lp(a) was significantly higher(p<0.05) in patients with diabetic retinopathy(nonproliferative, 38.6±33.6 mg/dl, proliferative, 39.5±32.1 mg/dl) than that of patients without retinopathy(23.3±25.3 mg/dl). The duration of diabetes was significantly longer(p<0.05) in patients with diabetic retinopathy(nonproliferative, 12.0 years, proliferative, 13.2 years) than that of patients without retinopathy(5.9 years). 2) Concentration of Lp(a) was significantly higher(p<0.05) in patients with diabetic nephropathy(36.5±39.3 mg/dl) than that of patients without nephropathy(23.3±17.8 mg/dl) and the duration of diabetes was also longer in patients with diabetic nephropathy(10.7±7.2 years vs 6.3±5.8 years, p<0.005). 3) Concentration of Lp(a) was significantly higher and the duration of diabetes was longer in patients with diabetic neuropathy than that of patients without neuropathy(35.9±31.7 mg/dl vs 23.2±25.1 mg/dl, p<0.05 and 10.8 years vs 6.2 years, p<0.005). 4) Concentration of Lp(a) was significantly higher in patients with three complications(53.6 mg/dl, p<0.005) and duration of diabetes was significantly longer in patients with two or three complications(11.3 years, 13.6 years, respectively, p<0.0001). than those in patients without complications. 5) When the patients were subgrouped according to the treatment modalities, there were no significant difference in Lp(a) concentration, however the duration of diabetes was longer in patient group treated with combination of insulin and oral hypoglycemics than that of the other groups(p<0.05). 6) In multivariate logistic regression analysis, concentration of Lp(a) ≥ 50 mg/dl was significantly correlated with diabetic retinopathy & nephropathy, but was not significantly correlated with diabetic neuropathy. Duration of diabetes(≥7 years) and total cholesterol(≥20 mg/dl) were signi5cantly correlated with diabetic retinopathy, nephropathy and neuropathy. Conclusions: Lp(a) concentration is increased in patients with diabetic microangiopathy and neuropathy compared with patients without these complications. So, Lp(a) may works as risk factor for diabetic microangiopathy and neuropathy, and further study to evaluate the role of Lp(a) as a risk factor of such complications would be necessary in large number of patients.

고빌리루빈혈증을 동반한 자가면역성 간염 1례

서영범,김성욱,장재식,강혁주,이중현,윤병구,김욱년,이광헌,이구,유석동,양창헌,이정호,이영현,이창우,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

자가면역성 간염은 대개 만성 경과를 가지며, 혈중 자가면역항체와 혈청 글로불린치의 상승, 그리고 조직학적으로 괴사 염증성 변화를 특징으로 하는 질환으로 아직 정확한 병인이 밝혀져 있지 않은 상태이다. 발병연령은 대개 젊은 영자(15-25세)에서 호발한다. 이 질환은 급성 간염의 임상경과를 보일 수 있으나, 심한 급성 간염이나 전격성 간염으로도 나타날 수 있는데, 이 경우 아주 나쁜 예후를 보인다고 한다. 치료는 자가면역성 간염 임상 경과의 다양성이나 병인, 병리기전의 불확실성에도 불구하고 대개 steroid 치료에 반응하는 것으로 알려져 있으며 대개 80%의 관해율을 나타내며 궁극적으로 간경변으로의 진행을 막을 수 있는 것으로 보인다. 저자들은 58세 남자에서 발생한 급성의 경과를 가지고 심한 황달을 동반한 자가면역성 간염을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Autoimmune hepatitis (AIH) is a chronic necroinflammatory liver disorder of unknown cause associated with circulating autoantibodies and a high serum globulin level. The age of onset of AIH show a peak between the age of 15 and 25 years. AIH can develop and be manifested as acute hepatitis, but severe form of acute hepatitis or fulminant hepatic failure has a poor prognosis. Although AIH is likely to progress from chronic active hepatitis to cirrhosis, steroid therapy can control the disease activity, prolong survival, improve the quality of life , and defer liver transplantation. In the present report we describe a 58-year-old man who admitted because of progressive jaundice and fatigue. He was diagnosed with AIH from laboratory test result showing positivity for antinuclear antibodies, anti-smooth muscle antibodies, and negativity for hepatitis viral markers and from liver biopsy. Steroid therapy, oral administration of prednisolone, was effective in improving the liver function test. Following liver biopsy 6 months after onset shows markedly improved necroinflammatory activity.

당뇨병 환자에서 Streptococcus pyogenes에 의한 Fournier's gangrene을 동반한 괴사성 근막염 1예

정소연,이영실,유석동 대한당뇨병학회 2001 임상당뇨병 Vol.2 No.4

괴사성 근막염과 Fournier's gangrene은 기본병리는 동일한 것으로, 독소를 생성하는 병독력이 있는 세균에 의한 광범위한 조직 괴사를 특징으로 하는 연조직 감염으로 드물고 급격히 진행하여 진단하기 어렵고 미만성 연조직 괴사와 독성 쇽 증후군으로 진행하므로 조기 진단과 적극적인 치료를 하지 않으면 치사율이 높은 질환이다. 특히 혈당조절이 불량하고 족부 궤양이 있는 당뇨병 환자에서 조기에 괴사성 근막염과 독성 쇽 증후군을 의심하고, 항균제를 투여하고 신속히 수술하여 괴사 조직을 제거해야 한다. 저자들은 중증 당뇨병 환자에서 Fournier's gangrene을 동반한 S. pyogenes에 의한 괴사성 근막염 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Necrotizing fasciitis is a nuncommon rapidly progressive and destructive infection of soft tissue, caused by toxin-producing virulent bacteria . Recently the re has been a dramatic increase in the recognition and reporting of necrotizing fasciitis due to Streptococcus pyogenes. It is commonly associated with toxic shocksyndrome and is usually rapidly fatal if not promptly recognized and aggressively treated. Fournier's gangrene is a widely destructive, gangrenous process of the genitalia. Necrotizing fasciitis and Fournier's gangrene occurmore common in diabetes. Early recognition, broad-spectrum a ntibiotics coverage and adequate debridement has been associated with improved survival. We report a case of necrotizing fasci it is caused by streptococcus pyogenes with Fournier's gangrene in a severe diabetic patient.

당뇨병성 자율 신경병증에서 99mTc-DISIDA를 이용한 담낭 배출율에 관한 연구

김인주,김용기,유석동,김성장,안준협 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.1

Purpose: We performed this study to evaluate the changes of gallbladder ejection fraction (GBEF) in diabetic patients with or without autonomic neuropathy. Materials and Methods: This study included 37 diabetic patients (25 women, 12 men, mean age 51 years) and 24 normal controls (10 women, 14 men, mean age 38 years). After intravenous injection of 185 MBq of 99mTc-DISIDA, serial anterior abdominal images were acquired before and after fatty meal. Regions of interest were applied on gallbladder and right hepatic lobe on 60 and 90 minute images to calculate GBEF. Results: GBEF was significantly reduced in diabetes with autonomic neuropathy (43±12.3%) and without autonomic neuropathy (57.5±13.2%) compared with normal controls (68±11.6%, p <0.05). And also, GBEF was significantly reduced in diabetes with autonomic neuropathy compared with diabetes without autonomic neuropathy (p <0.05). Fasting blood glucose level, age, sex, hemoglobin A1c, body mass index, serum lipid level were not different in these two ditic patient groups (p>0.05). When 50.2% of GBEF was used as the criteria for diabetic autonomic neuropathy, the sensitivity and specificity were 80%, 76.5%, respectively. The area under receiver operating characteristic curve was 0.846. Conclusion: GBEF of diabetic patients with autonomic neuropathy was significantly reduced than that of diabetic patients without autonomic neuropathy. (Korean J Nucl Med 2000;34:55-61)

당뇨병성 신경병증 환자에서 Amitriptyline 투여 중에 발생된 항이뇨호르몬 부적절 분비 증후군 1 예

이영현,이영실,유석동 대한당뇨병학회 1999 Diabetes and Metabolism Journal Vol.23 No.6

인슐린비의존형 당뇨병 환자에서의 수용성 E-selectin과 P-selectin 농도

김용기,김인주,유석동 대한당뇨병학회 1998 Diabetes and Metabolism Journal Vol.22 No.1

Otsuka Long-Evans Tokushima Fatty(OLETF) 쥐에서 내피세포 의존성 혈관이완 장애의 기전

전국진,손석만,김인주,김치대,유석동,김용기 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.26 No.1

연구배경:여러 연구에서 당뇨병 환자와 당뇨병 동물모델에서 내피세포 의존성 혈관 이와 반응이 저하되어 있음이 밝혀졌다. 이에 대한 여러가지 가설들이 제시되었으며, 특히 산화 스트레스가 중요한 원인으로 생각되고 있다. 따라서, 본 연구에서는 제2형 당뇨병 동물모델인 OLETF 쥐에서 내피세포 의존성 혈관 이완반응이 감소되는 기전을 알아보고자 하였다. 방법:제2형 당뇨병 동물모델로 생후 30주된 수컷 OLETF 쥐와 비당뇨병 대조군으로 생후 30주된 수컷 LETO 쥐의 대동맥을 적출하여 혈관 이완반응을 측정하였고, 대동맥조직에서 eNOS의 발현과 superoxide 음이온의 생성량을 측정하였다. 결과:내피세포층이 존재하는 대동맥환을 U46619로 처리하여 혈관을 수축시킨 후 acetylcholine에 대한 혈관 이완반응을 보았을 때 OLETF 쥐에서 대조군인 LETO 쥐보다 의미있게 이완반응이 저하되었지만, acetylcholine에 대해 감소되었던 혈관 이완반응은 SOD(500U/mL)로 전처리하면 의미있게 회복되었다 eNOS의 발현은 OLETF 쥐와 LETO 쥐 사이에 차이가 없었다. 대동맥 조직에서 생성된 superoxide 음이온의 생성량은 OLETF 쥐와 LETO 쥐 사이에 차이가 없었다. 대동맥 조직에서 생성된 superoxide 음이온의 생성량은 OLEFT 쥐에서 LETO 쥐보다 의미있게 높았다. DPI(10μmol/L)와 SOD(500U/mL)로 처리하였을 때 OLETF 쥐와 LETO 쥐의 대동맥조직에서 superoxiede 음이온의 생성량이 두 약물로 처리하지 않은 vehicle 군보다 의미있게 감소하였지만, allopurinol(100μmol/L), rotenone(100μmol/L)과 L­NMMA(10μmol/L)으로 처리하였을 경우에는 superoxide 음이온의 생성량에 변화는 없었다. 결론:이상의 결과로 OLETF 쥐에서 내피세포 의존성 혈관 이완반응이 감소된 것은 산화질소의 생성이 감소항였기 보다는 혈관조직의 NAD⒫H oxidase에 의해 superoxide 음이온 생성이 증가하여 산화질소의 생체 내 이용률이 감소하였기 때문이다. Background : Impaired vascular endothelium-dependent relaxation and augmented contractile responses have been reported in several long-term animals hyperglycemia models and human diabetic patients. Since oxidative stress has been implicated as a contributor to impaired vascular function, the mechanism of an impaired endothelium-dependent vasodilation in Otsuka Long-Evans Tokushima Fatty (OLET) rats was investigated. Methods : This present study was undertaken to characterize both the vascular production and the enzymatic source of the superoxide anion in the type 2 diabetic rats. Results : In the thoracic aortas of OLETF rats, endothelium-dependent relaxation was markedly attenuated compared to that of the control rats (LETO, Long-Evans Tokushima Otsuka) in association with a significant increase in superoxide production (2421.39±407.01 nmol/min/mg). There was no difference in eNOS expression between the OLETF rats and LETO rats. The increased production of superoxide anion was significantly attenuated by diphenyleneiodonium (DPI,10 ?ol/L), NAD (P)H oxidase inhibitor. In line with these results, studies using various enzyme inhibitors such as DPI, allopurinol, rotenone and L-NMMA suggest that the main source of superoxide anions in the aorta is NAD (P)H oxidase. Conclusion: These results suggest that enhanced NAD(P)H oxidase activity and reduced nitric oxide(NO) availability through an interaction between NO and superoxide anion contribute to the impaired endothelium-dependent vasodilation in OLETF rats (J Kor Diabetes Asso 26:46~56, 2002).