말단비대증 환자의 뇌하수체 종양조직에서 H - ras 유전자 변이의 가능성

임승길(S . K . Lim),권이현(Y . H . Kwon),정윤석(Y . S . Chung),안광진(K . J . Ahn),이은직(E . J . Lee),김경래(K . R . Kim),이현철(H . C . Lee),허갑범(K . B . Huh),김태승(T . S . Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.3

N/A Backround: Little is known about the mechanism of tumorigenesis in pituitary adenomas. An important finding in somatotroph adenomas is that a somatic mutation may convert a G protein, Gs(α) into a putative oncogene termed gsp via point mutations at two critcal sites. The ras protooncogenes are structurally related to the G-protein family and are involved in cell proliferation and differentiation. Although ras oncogene mutations have been indentified in a wide variety of human neoplasm, only one case was reported as containting single point mutation in a patient with invasive prolactinoma, In this report we used oligonucleotide-specific hybridization to screen ras mutations in 13 acromegalic tumors. Methods: Pituitary tissue samples were derived from a central portion of the paraffin embedded pituitary tumor to minimize the possibility of contamination with normal tissue. Genomic DNA was isolated and purified from tumor tissue and amplified by the standard PCR method. Amplified DNAs from each of the region of H-ras genes (12/13 and 61) were analyzed for potential ras mutations using oligonucleotide-specific hybridization as described previously. Results: Wild type radiolabelled oligoncleotides were hybridized to the amplified DNAs from the patients' tumor and to the positive specimens. They were, however, easily striped out at 68℃ by nonstringent washing procedures except control (wild type) specimens. All radiolabelled mutant oligonucleotides could be easily striped out of 13 specimens except a control mutant specimen by the same procedure. Conclusion: We could not find any H-ras mutation that might not be frequently found in acromegalic patients, and that gsp (Gsa mutation) or mutations in the PKA system-related proteins might be the main oncogene in acromegalic patients. However further efforts to find the other somatic mutations including K-ras and N-ras should be given to these patients for more precise understanding of pathogenesis and for planning of the better treatment.

중증 부갑상선 기능항진중에서 부갑상선 결절내 Calcitriol 직접 주입술 및 충격요법 병용치료의 장기간 연구결과

신석균(S. K. Shin),황재하(J. H. Hwang),송현용(H. Y. Song),노현진(H. J. Noh),최규헌(K. H. Choi),임승길(S. G. Lim),이호영(H. Y. Lee) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1

N/A Severe hyperparathyroidism(i-PTH>1,000pg/ml, dia-meter of nodules>1.0cm, and hypercalcemia) in dialysis patients may be resistant to conventional calcitriol- pulse therapy. To assess the usefulness of direct calcitriol injections in restoring the responsiveness to calcitriol, we performed a prospective study in 23 dialysis patients(mean age 42.3 years, M: F 0.9: 1, CGN 14, hypertension 4, lupus nephritis 2 & others 3, mean duration of dialysis 9.5 years, HD: CAPD 9: 14) who had severe hyperparathyroidism resistant to calcitriol pulse therapy for more than 2 months and had no ectopic gland in Sestamibi parathyroid scan. We three repeatedly injected calcitriol of dose(μg) equal to 3-D nodule volume(cm(3)) under U.S.(Acuson Computa Sono, California, USA, 7MHz probe) for 1 week and concurrently began calcitriol-pulse therapy(0.75-1.0μg/day, t.i.w.) after 3rd injection. All patients were followed up by serum i-FI H(Allegro Intact FPH kits, Nichols Ins.), calcium, phosphate, and U.S. after 7 days, 1 month, 6 months, and 1 year of 3rd calcitriol injection. These combination therapy could significantly decrease i-PTH level and gland volume in patients with resistant secondary hyperparathyroidism on conventional calcitriol therapy and the response were main-tained for one year after start of these therapy. The complete response group was the patients with lower baseline i-FFH levels compared to those with partial and non-response(1001.7±150.2 vs. 1521.8±328.3, 1569.2 ±344.3pg/ml, p<0.05, respectively). The patients with baseline i-PTH of less than l,200pg/ml or gland volume of less than 1.5cm were well responded to the three consecutive direct calcitriol injection and pulse combination therapy(i-PTH; PPV 77.8%, NPV 92.8%, gland volume', PPV 87.5%, NPU 93.3%). No severe adverse effect was observed during this study. In conclusion, direct calcitriol injections into the parathyroid nodules and pulse combination therapy could be useful in secondary resistant hyperparathyroidism patients with conventional calcitriol therapy especially in those with i-PTH of less than 1,200pg/ml or gland volume of less than 1.5cm. However, sugical management may be indicated in patients with higher i-PTEI levels or larger gland volume than these.

만성적 발목 불안정성이 있는 태권도 선수의 고관절과 발목 부위 근력

임미영 ( M. Y. Leem ),박명수 ( M. S. Park ),임승길 ( S. K. Lim ) 한국운동생리학회(구-한국운동과학회) 2010 운동과학 Vol.19 No.4

고관절 및 발목의 근력과 안정성은 정상 보행과 신체활동에 있어서 중요한 요소이다. 본 연구의 목적은 만성적 발목 불안정성이 있는 태권도 선수를 대상으로 환측과 건측의 고관절 외전근과 내전근, 발목의 외번과 내번근, 저측굴곡근과 배측굴곡근의 근력 차이를 종합적으로 규명하는 데 있다. 연구대상은 한쪽 발목에 만성적 불안정성이 있는 태권도 선수 15명을 대상으로 하였다. 환측과 건측 간의 근력 측정은 트렌델렌버그 검사와 등속성 근력 검사를 이용하여 측정하였다. 트렌델렌버그 검사 결과, 환측 고관절 외전근 약화를 나타내는 양성 반응이 46.7%에서 나타났다. 그러나 등속성 검사를 이용한 고관절 외전력 및 내전력에는 유의한 차이가 없었다. 등속성 검사를 이용한 발목의 외번력은 180o/s에서 측정한 환측의 피크토크와 단위체중당 피크토크가 건측에 비해 유의하게 낮았다(p<.05). 발목의 저측굴곡력 및 배측굴곡력에는 유의한 차이가 없었다. 이상의 결과를 바탕으로 결론을 내리면, 만성적 발목 불안정성을 가지고 있는 태권도 선수의 재활운동을 구성하기 이전에 고관절 외전력 약화에 대한 사전 검사가 이루어져야 하며, 고관절 외전력 약화가 있을 경우, 외전력 강화를 위한 운동 프로그램이 재활 및 재손상 방지를 위해서 반영되어야 한다. 또한 만성적 발목 불안정성을 가지고 있는 태권도 선수들의 발목 외전력 강화를 위한 프로그램이 적극적으로 권장된다. Strength and stability of hip and ankle muscle are important factors for normal gait and physical activity. The aim of this study was to investigate the strength difference of hip and ankle muscle between involved and non-involved side in taekwondo athletes with chronic ankle instability. A total of 15 subjects with unilateral chronic ankle instability were recruited. As a result of Trendelenburg`s test, positive response that indicate weakness of hip abductor was 46.7% at involved side. However, there were no significance difference between involved and non-involved side in isokinetic strength of hip abductor and adductor. Isokinetic strengths(peak torque and peak torque % body weight) of ankle evertor at 180˚/s were significantly less on the involved side than the non-involved side(p<.05). No significant difference were noted in ankle plantar flexor and dorsiflexor strength. Taken together, we conclude that screen test for weakness discrimination of hip abductor should be performed before rehabilitation program was designed for taekwondo athletes with chronic ankle instability. In the case with weakness of the hip abductor, strengthen exercise of hip abductor should be involved in the rehabilitation for functional recovery and re-injury prevention. Also, strengthening of ankle evertor is recommended for taekwondo athletes with chronic ankle instability.

갑상선 질환에 있어서의 골밀도의 변화

전근재(G . J . Jeon),임승길(S . K . Lim),이현철(H . C . Lee),김경래(K . R . Kim),허갑범(K . B . Huh) 대한내과학회 1988 대한내과학회지 Vol.35 No.6

N/A We studied 59 patients who had received a diagnosis of graves' disease or myxedema by dual photon absorptiometry from August 1986 to July 1987 at the Department of Internal Medicine, Yonsei University Severance Hospital. The results were summarized as follows: 1) Patients with Graves' disease of a mean duration of 19.2 weeks demonstrated an average of 9.37 mg/dl Ca and 4.29 mg/dl P in their blood samples while the 24 hr urine specimen showed 194.26 mg/dl 24 hr of Ca and the P revealed 520.36 mg/24 hr, which is higher than those of myxedema. 2) The patients with Graves' disease revealed a prevalance of osteoporosis in the following, Ward's triangle 18,8%, femora) neck 20.8%, trochanter 25%, but the spine, while observed at 22.9% in hyperthyroidism, also was detected at 18.2% in myxedema. 3) In females with Graves' disease, the values of BMD were relatively lower than those of the control group but showed a greater at traction to osteoporosis than the males. 4) Most womon in their postmonopaunal poriod showed a strong tondency to develop osteoporosis in the femoral neek but they demonstrated a greater relationship to the spine. 5) Even after treatment, the BMD revealed a tendency to continue increasing, however, there was still a possibility for incomplete recovery. Excess thyroid hormones lead to negative bone mineral balance. The revealed bone loss was clinically significant in postmenopausal women despite its short dyratuib abd ut aooeared ti be at keast oartuakkt reversubke after treatment.

내과 질환으로 입원한 환자의 영양상태

김유리(Y . L . Kim),김현만(H . M . Kim),임승길(S . K . Lim),이현철(H . C . Lee),허갑범(K . B . Huh),최은정(E . J . Choi),문수재(S . J . Moon) 대한내과학회 1988 대한내과학회지 Vol.35 No.5

N/A Nutritional assessment was performed on admission of 106 consecutive medical patients by anthropometry, biochemical tests, and dietary survey. Factors included in anthropometric measurements were height, weight, triceps skin fold, and mid-arm muscle circumference. Biochemical tests included serum total protein, serum albumin, and a complete blood cell count. Dietary intakes of nutrients before the development of disease were investigated by the 24 hour reca11 method. Using these parameters for malnutrition, (anthropometry<90% of standard value, serum albumin<3.0 g %, total lymphocyte count<1200/mm, intake of total calorie and protein<80fo of RDA, 39.6% of the patients showed a moderate degree of malnutrition. Based upon the above result, it could be concluded that the prevalence of malnutrition in hospitalized medical patients is similar to that indicated in foreign reports. This suggests that nutritional education for the general population, assessment of the nutritional status of patients, and nutritional support are needed for the prevention and effective treatment of disease.

인슐린 자가 항체에 의해 유발된 저혈당증 1예

임승길,김경래,이수곤,이관우,황성오,허갑범,이현철,이혁우 대한내분비학회 1989 Endocrinology and metabolism Vol.4 No.1

Autoimmune hypoglycemia is characterized by hyperinsulinemia, fasting hypoglycemia, and presence of insulin autoantibody without previous exposure to exogenous insulin. Though this conditions were reported exclusively in Japan, we recently experienced the first case of autoimmune hypoglycemia in Korea and present it with a literature review. (J Kor Soc Endocriuol, 4: 72~76, 1989)

한국 성인에서 비알콜성 지방간의 중증도에 따른 대사이상의 특징

김형진,김대중,김수경,김세화,이유미,안철우,차봉수,송영득,임승길,김경래,이현철,허갑범 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.4

연구배경: 30세 이상의 성인 한국인에서 지방간의 중증도와 대사증후군의 여러 요소들 (특히 인슐린저항성 및 중심성비만)과의 관련성을 분석하고자 하였다. 방법: 대상자는 2001년 4월부터 6월까지 건강검진센터를 방문한 사람들 중 만성 바이러스성 간염이나 일주일에 2회 이상 음주력이 있는 사람들을 제외한 1074명 (남자 502, 여자 572)에서 문진, 신체검사, 채혈 그리고 복부초음파를 시행하였다. 결과: 1074명중 522명에서 지방간이 양성이어서 양성율은 49%였으며 남성은 여성에 비해 높은 유병률을 보였다. (57 vs 42%, p<0.05). 당뇨병, 비만 그리고 이상지질증을 가지지 않은 사람들에서 비알콜성 지방간의 유병률은 20%였다. 지방간이 양성인 522명중 218명은 경도, 273명은 중등도, 31명은 중증의 지방간 소견을 보였다. 체질량지수, 허리둘레, 체지방률, 수축기혈압, aspartate aminotransferase, alanine aminotransferase, 총콜레스테롤, 중성지방, 그리고 총콜레스테롤/고밀도지단백 비는 지방간의 중증도에 따라 의미있게 증가하는 양상을 보였다(p<0.05). 다중회귀분석을 시행하였을 때 지방간의 중증도를 잘 반영하는 인자로는 허리둘레, alanine aminotransferase, HONA_IR, 총콜레스테롤/고밀도지단백비, aspartate aminotransferase, 그리고 수축기혈압의 순서로 나타났다. 공복혈당장애, 고혈압 및 인슐린저항성은 지방간을 가진 군에서 대조군보다 의미있게 높은 빈도를 보였을 뿐만 아니라 지방간의 중증도에 따라 차이를 보였다(p<0.05). 인슐린저항성은 심한 지방간에 비교위험도가 14.7(CI; 6.8∼32.0), 중등도의 지방간에서 6.9(CI; 4.6∼10.3), 경도의 지방간에서 5.7(CI; 3.6∼8.8)이었으며 HOMA_IR의 상위 1/4을 인슐린저항성이 있는 군으로 정의하였을 때 각군에 인슐리저항성을 가진 비율은 7.6, 32.0, 36.0, 그리고 55%였다(p<0.05). 지방간의 중증도에 따른 비알콜성 지방간염의 고위험군 비율은 각각 5.0, 21.6, 27.8, 그리고 58.1%였다(p<0.05). 결론: 우리나라의 비알콜성 지방간의 빈도는 서구인에 비해 높은 것으로 나타났다. 또한 비알콜성 지방간이 있을 경우 대사증후군과 관련된 여러인자들(특히 인슐린저항성과 중심성비만)과 비알콜성 지방간염의 위험이 현저히 증가하며 초음파의 중증도 분류에 따라 비례하였다. Background: We evaluated the frequency of non-alcoholic fatty liver disease, and the associations between the metabolic abnormalities and severity of non-alcoholic fatty liver disease in Korean adults using ultrasonography. Methods: We examined 1074 Korean adults above the age of 30 years, comprising of 502 men and 572 women, participating in medical check-ups at the Health Promotion Center. Hepatitis B and C serologies were negative, and the average weekly alcohol intake was ≤ 2 standard drinks. A standard interview, physical exam and biochemical study, were conducted, and an experienced operator carried out ultrasound liver studies. Results: 522 of the subjects had non-alcoholic fatty liver disease, and the remaining 552 did not. The frequency in the men was higher than that in the women (57 vs 42%, p<0.05). The frequency of non-alcoholic fatty liver disease in the subjects without diabetes, obesity or dyslipidemia was 20%. We classified subjects into 4 groups: the controls (n=552) and those with mild (n=218), moderate (n=273) or severe fatty liver disease (n=31), according to their ultrasonographic findings. BMI, waist circumference, body fat, systolic blood pressure, aspartate aminotransferase, alanine aminotransferase, total cholesterol, triglyceride, the total-to HDL-cholesterol ratio, impaired fasting glucose, hypertension and insulin resistance, were all significantly increase with the increased severity of non-alcoholic fatty liver disease (p<0.05). Following the multiple regression analyses, waist, alanine, aminotransferase, HOMAIR, the total- to HDL-cholesterol ratio, aspartate aminotransferase and systolic blood pressure, were all associated with the severity of non-alcoholic fatty liver disease. Odd ratios of insulin resistance in the mild, moderate and severe non-alcoholic fatty liver disease were 14.7 (CI: 6.8∼32.0), 6.9 (CI: 4.6∼10.3) and 5.7 (CI 3.6∼8.8), respectively. The percentages of subjects with insulin resistance in each group were 7.6, 32.0, 36.0 and 55.0% (p<0.05), respectively. The percentages of subjects with risk of non-alcoholic steatohepatits in each groups were 5.0, 21.6, 27.8 and 581% (p<0.05) respectively. Conclusion: The frequency of non-alcoholic fatty liver disease was relatively high in Korean adults. Proportional differences in metabolic abnormalities, relation to the severity of non-alcoholic fatty liver disease, were found by ultrasonography (J Kor Soc Endocrinol 17:514∼525, 2002).

난소과자극 증후군 1예

이병석,박기현,박찬규,허갑범,이현철,임승길,조용욱,김유곤 대한내분비학회 1988 Endocrinology and metabolism Vol.3 No.2

Ovarian hyperstimulation syndrome (OHS) is a rare complication in the use of human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG) for ovulation induction. The pathophysiology is unclear and treatments are mainly conservative. We presented a case of ovulation induction with HMG and HCG in secondary amenorrhea due to hypogonadotropic hypogonadism after brain surgery for craniopharyngeoma with abscess formation. A brief review on the literatures was made in comment.

당뇨병성 경화부종 1예

이관우,허갑범,임승길,박진현,이현철 대한당뇨병학회 1989 Diabetes and Metabolism Journal Vol.13 No.1

인슐린 비의존형 당뇨병 환자에 있어서의 체중변화에 관한 연구

이현철,허갑범,임승길,김현만,조준구,황용 대한당뇨병학회 1986 Diabetes and Metabolism Journal Vol.10 No.1