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인슐린비의존형 당뇨병환자에서 허혈성 심장질환의 선별검사로서 관상동맥 칼슘침착수치 측정의 유용성
임승길(Sung Kil Lim),이종호(Jong Ho Lee),이현철(Hyun Chul Lee),송영득(Young Duk Song),김경래(Kyung Rae Kim),허갑범(Kap Bum Huh),윤용석(Yong Seok Yun),이유미(Yu Mie Rhee),심대근(Dae Keun Sim),신성관(Sung Kwan Sin),박병규(Byung Ku Park 대한내과학회 1999 대한내과학회지 Vol.56 No.3
N/A Patients with NIDDM are at increased risk for the development of coronary atherosclerosis and experience more silent myocardial infarction than non-diabetic subjects. The screening tools for early detection of coronary artery disease without significant narrowing has been requested in diabetic patients. Coronary artery calcification (CAC) score, quantified by electron beam computed tomography (EBT), have been reported to correlate with the amount of atherosclerotic plaque and vascular luminal narrowing. We investigated the distribution of CAC score and associated risk factors in asymptomatic NIDDM patients and patients with ischemic heart disease to estimate the usefulness of CAC as a screenig tool for ischemic heart disease in asymptomatic diabetes. Method : 136 NIDDM patients without any symptom of coronary artery disease and 37 patients with significant coronary artery stenosis were included. CAC were measured by electron bean tomography (ultrafast CT). Forty contiguous 3-mm thickness transverse two-dimensional sections were obtained through root of aorta and heart. Coronary calcification were defined as the presense of at least two adjacent pixel within the border of visualized coronary artery with CT number of at least 130 HU. Body mass index, waist-hip ratio were measured and body fat components were counted by impedence method. Visceral fat versus subcutaneous fat ratio were calculated by abdominal computed tomography. Plasma lipid profile, fasting insulin, C-peptide level, HbA1c concentration were measured. Correlations between natural log of CAC score and clinical parameters were evaluated and multiple regression analysis with natural log of CAC score as a independent variable was performed. Coronary angiography were performed in 17 asymptomatic NIDDM patients.. Result : CAC score was significantly higher in male than female subjects and increased significantly with aging (p<0.01). In patients with hypertension, previous history of cerebrovascular or peripheral vascular disease (p<0.05), CAC score was significantly increased. The CAC score showed significant positive correlations with smoking amount, duration of diabetes and a negative correlation with HDL-cholesterol (p<0.05). There were no association between CAC score and total cholesterol, LDL-cholesterol, waist to hip circumference ratio, or fasting insulin levels. After adjustment of compounding variables (age, sex), duration of diabetes, amount of smoking and previous history of atherosclerotic vascular disease were shown to be associated with CAC score. In multiple logistic regression analysis with natural log of CAC score as dependent variable, age, HDL-cholesterol, duration of diabetes, male gender were found to be significant independent variables. Seventeen diabetic patients with high CAC score, were taken coronary angiography and significant luminal narrowings (more than 50%) of coronary artery were documented in 16 patients. But, In 7 out of 17 patients with coronary one-vessel disease, coronary calcification were not detected by EBT. Conclusion : coronary artery calcium score quantified by electron beam computed tomography may be useful for screening of preclinical or asymptomatic coronary artery disease in asymptomatic NIDDM patients.
Somatostatin 수용체 스캔에 양성인 갑상선 여포선종이 동반된 말단비대증 1예
권석호,황영웅,박용범,윤용석,원영준,임승길,이현철,허갑범 대한내과학회 1997 대한내과학회지 Vol.53 No.3S
말단비대증으로 진단된 48세 여자에서 somatostatin 수용체 스캔에 양성인 갑상선종양을 발견하여, 병리소견상 갑상선 여포선종으로 밝혀진 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Recently, the new technique that allows the in vivo visualization in man of the somatostatin receptor positive tumor after iv adminstration of the 123I-coupled somatostatin analogue Tyr-octreotide (somatostatin receptor scan) was developed. We have experienced a forty eight-year-old female patient with acromegaly and multiple thyroid nodules. Somatostatin receptor scan was performed. Unexpectedly, both pituitary tumor and multiple thyroid nodules were presented with positive by somatostatin receptor scan and we thought that multiple thyroid nodules might be malignancy, probably medullary thyroid carcinoma. Therefore, bilateral subtotal thyroidectomy was performed and pathologic finding showed thyroid follicular adenoma.
우측 쇄골하 동맥과 흉벽을 침범한 침습성 Aspergillosis 1 예
이석,최병현,민유홍,김성철,한지숙,윤용석,서형찬,고윤웅,유내춘,정소영 대한내과학회 1997 대한내과학회지 Vol.53 No.2
Invasive aspergillosis is an infection that occurs in immunocompromised patients. Its prevalence was increased in the last decade with progression of antineoplastic chemotherapy and immunosuppressive therapy after transplantation. Because it carries a high mortality and morbidity, early diagnosis and aggressive treatment are critical for successful management. In many patients, invasive aspergillosis remains confined to the lung although direct extension to pleural cavity or pericardium has been reported. However great vessel involvement is rare. Therefore we report a case of invasive aspergillosis involving right subclavian artery and chest wall in a patient after chemotherapy for acute lympoblastic leukemia.
초기 당뇨병성 신증과 동반된 Erythropoietin 결핍성 빈혈에 대한 합성 조혈호르몬의 치료효과
김대중,김수경,김형진,김유미,윤용석,안철우,차봉수,송영득,임승길,김경래,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5
연구배경:본 연구자 등은 과거에 진행성 당뇨병성 신증 이전 단계에서 원인미상의 빈혈을 동반한 환자들을 관찰할 수 있었으며, 빈형에 대한 Epo의 반응성 감소, 즉 Epo의 상대적 결핍이 빈혈의 원인이 될 수 있음을 보고한 방 있다. 이에 본 연구의 목적은 초기 당뇨병성 신증과 동반된 Epo 결핍성 빈혈에서 rHuEpo의 치료효과를 보고자 하였다. 방법:총 29명의 Epo 결핍성 빈혈을 가진 당뇨병 환자를 Epo 투여군(남:여=8:12, 평균나이 52.9±12.4세)로 무작위 배정하였다. Epo 투여군에게는 rHuEpo(Epokine,㈜제일제당)을 하루 4,000단위씩 주 3회 피하주사하였고 최대 8주간 사용하였다. 추적기간 동안 혈색소치가 2g/dL 이상 상승하거나 혈색소치가 남자 14g/dL, 여자 13g/dL 이상으로 상승한 경우를 반응군으로 하였고 나머지를 비반응군으로 하였다. 결과: Epo 투여군과 대조군 사이의 임상적 및 생화학적 특성의 차이는 없었다. 반응군(n=14)은 비반응군과 대조군에 비해 치료 8주째 의미있는 혈색소치의 상승을 보였다(각각 13.6±1.0, 10.1±1.5, 11.2±1.2g/dL, p<0.01). 반응군의 rHuEpo의 평균투여기간은 4.9±2.3주였다. Epo 투여군중 반응군과 비반응군 사이의 성별, 연령, 당뇨병의 유병기간, 혈청 크레아티닌치, 24시간 소변내 알부민농도, 당뇨병성 미세혈관합병증의 유무, 그리고 혈청 Epo 농도의 차이는 관찰되지 않았다. 그러나 반응군은 비반응군에 비해 혈청 ferritin(각각 240.3±108.4, 25.8±3.0㎍/L, p<0.05)과 transferrin saturation(각각 32.7±7.9, 21.2±5.3%, p<0.05)이 의미있게 높은 소견을 보였다. 결론:이상의 결과로 초기 당뇨병성 신증과 동반된 Epo 결핍성 빈혈에서 rHuEpo의 투여를 통해 빈혈을 교정할 수 있었으며, rHuEpo에 대한 반응의 정도는 당뇨병과 관련된 임상적 특성보다는 기능성 철결핍 정도와 관련되어 있다고 생각된다. Background : We have previously reported that reduced erythropoietin (Epo) responsiveness to anemia could explain the anemia in diabetic patients before advanced diabetic nephropathy. Thus, the aim of this randomized prospective study is to investigate the therapeutic effect of recombinant human erythropoietin (rHuEpo) on anemia with Epo deficiency in early diabetic nephropathy. Methods : Twenty-nine diabetic patients with the normocytic normochromic anemia of Epo deficiency were randomized into Epo-treatment group (n=20, M:F=8:12, mean age=52.9±9.2) and control group (n=9, M:F=4:5, mean age=53.6±12.4). Twenty patients of Epo-treatment group were treated with rHuEpo (Epokine® (CheiUedang Co.) 4,000 unit/ day SC., 3 times/ week) for 8 weeks. The Epotreatment group were divided into the responder or non-responder. Patients with increments in Hemoglobin (Hb) during the follow-up duration was above 2g/ dL, or with the final Hb was above 14g/ dL in men or 13g/ dL in women were decided the responder. In order to analyze factors affecting the therapeutic effects of rHuEpo, the clinical and biochemical characteristics were compared between the responder and non-responder group. Results : There was no difference in the clinical and biochemical characteristics between the Epo-treatment and the control group at randomization. The responder group (n=14) had significant increments in Hb, compared to the non-responder group (n=6) or the control group (13.6±1.0 vs. 10.1±1.5 vs 11.2±1.2g/ dL, p<0.001, respectively). The treatment duration of rHuEpo in the responder group was 4.9±2.3 weeks. Among the Epo-treatment group, there was no differences between the responder and the non-responder group in sex, age, duration of diabetes, serum creatinine level, 24 hour urinary album in excretion rates, HbA_1c, frequency or severity of microangiopathy, and serum Epo level. However, the responder group had higher serum ferritin (240.3±108.4 vs 25.8±3.0 ㎍/L, p<0.05) and transferin saturation level (32.7±7.9 vs 21.2±5.3 %, p<0.05). Conclusion : These results concluded that the administration of rHuEpo could be useful in treating anemia with Epo deficiency in early diabetic nephropathy and that the degree of iron storage and functional iron deficiency might affect the therapeutic effects of rHuEpo on this type of anemia (J Kor Diabetes Asso 25:364~373, 2001).