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선천성부신과다형성증 환자에게서 발생한 부신 골수지방종 1예
이정훈 ( Jung Hoon Lee ),김지윤 ( Ji Yoon Kim ),권재완 ( Jae Wan Kwon ),이준기 ( Joon Kee Lee ),전언주 ( Eon Ju Jeon ),정의달 ( Eui Dal Jung ) 대한내과학회 2015 대한내과학회지 Vol.89 No.3
Adrenal myelolipoma (AML) is a rare, usually benign, and nonfunctioning tumor. About 7-15% of adrenal incidentalomas are AMLs, composed of normal hematopoietic elements and mature adipose tissue. AML is usually unilateral and < 4 cm. It is often discovered incidentally on abdominal computed tomography or magnetic resonance imaging. It is related to a chronic increase in adrenocorticotropic hormone, such as that observed in patients with congenital adrenal hyperplasia, Cushing disease, Conn`s syndrome, and pheochromocytoma. Here, we report a 28-year-old man diagnosed with non-salt-losing congenital adrenal hyperplasia with huge bilateral AMLs and a literature review. (Korean J Med 2015;89:340-345)
갑상선결절의 초음파유도하 세침흡인검사에서 Galectin-3의 진단적 유용성
김현숙 ( Hyun Sook Kim ),조창호 ( Chang Ho Cho ),정의달 ( Eui Dal Jung ),윤현대 ( Hyun Dae Yoon ),배종엽 ( Jong Yup Bae ),손호상 ( Ho Sang Shon ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2
Background and Objectives: Fine needle aspiration biopsy (FNAB) is considered as the most feasible preoperative diagnostic tool for thyroid lesions. However, indeterminate results of FNAB are common, so many methods were developed as supportive preoperative diagnostic modalities in indeterminate results of FNAB. In our previous studies, galectin-3 was expressed preferentially in thyroid malignancies of postoperative tissue specimen. In the present study, we evaluated whether galectin-3 immunohistochemistry (IHC) is useful as a preoperative diagnostic tool in thyroid nodules. Materials and Methods: A total of 151 thyroid nodules were performed US-guided FNAC and obtained from patients who underwent thyroidectomy were evaluated using papanicolaou-stained slides and cell blocks with galectin-3 IHC. IHC for Galectin-3 was performed. Cytologic diagnoses were correlated with the results of galectin-3 and categorized into 3 groups (benign, indeterminate, malignancy) and compared with the corresponding histologic diagnoses. Results: Of 151 specimens, 113 (74.8%) were malignant. When the histologic diagnoses were compared with the galectin-3 IHC, there were 14 (9.2%) discrepant cases. In the result of US-guided FNAB, sensitivity, specificity, positive-predictive value, and negative predictive value of galectin-3 IHC were 90.2, 92.1, 97.1, 76.1%. In the indeterminate result of US-guided FNAB, sensitivity, specificity, positive-predictive value, and negative predictive value of galectin-3 were 50, 91.4, 60, 96.9%. Conclusion: Galectin-3 IHC is a supplementary marker for the preoperative diagnoses of thyroid nodules in the US-guided FNAB. In the indeterminate of FNAB, galectin-3 IHC is not a reliable method for diagnosis, but negative staining of galectin-3 may raise the possibility of benign thyroid nodules.
김현숙 ( Hyun Sook Kim ),손호상 ( Ho Sang Shon ),정의달 ( Eui Dal Jung ) 대한갑상선학회 2009 International Journal of Thyroidology Vol.2 No.2
Background and Objectives: Ghrelin stimulates growth hormone secretion and food intake. Ghrelin regulates energy expenditure. Thyroid dysfunction is associated with weight changes and metabolism. However, findings between serum ghrelin level and hypothyroidism are conflicting. Materials and Methods: We studied 20 overt hypothyroidism patients, 16 subclinical hypothyroidism patients, and 45 euthyroid controls. Thyroid hormones, thyroid autoantibodies, fasting glucose, acylated ghrelin, insulin, and urine iodide were measured in all subjects. Results: Baseline characteristics (age, sex, BMI, waist circumference) between hypothyroidism (subclinical and overt hypothyroid) patients and controls were similar. Serum acylated ghrelin levels in hypothyroidism patients did not differ from those in controls (15.7±18.9 pg/ml vs 20.2±37.2 pg/ml, p=0.714). Serum insulin levels in hypothyroidism patients did not differ from those in controls. serum acylated ghrelin levels and insulin levels of overt hypothyrodism were not different compared with euthyroid controls (acylated ghrelin; 16.8±20.8 pg/ml vs 20.2±37.2 pg/ml, p=0.43). Conclusion: Serum acylated ghrelin levels in hypothyroidism patients did not differ from those in controls. Further evaluations are needed to clarify relationship between ghrelin levels and thyroid dysfunction.
가성가성 부갑상선 기능저하증 환자에서 발생한 올브라이트 유전성 골이영양증 2예
원종훈 ( Jong Hoon Won ),현동녘 ( Dong Nyeok Hyun ),박준수 ( Joon Soo Park ),정현 ( Hyun Chung ),정의달 ( Eui Dal Jung ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.7
A 36 year-old man and his 6 month-old daughter presented with multiple, slightly depressed, skin-colored, hard nodules and plaques on the abdomen, back, and both extremities. They also showed abnormal physical appearance, including short stature and neck, round face, and short digits, which suggested Albright`s hereditary osteodystrophy (AHO). Histopathologically, various sized bony spicules were present in the dermis. The laboratory results showed normal serum calcium, phosphorus and parathyroid hormone levels. On the basis of clinical, laboratory and histologic findings, we diagnosed these cases as Albright`s hereditary osteodystrophy with cutaneous ossification occurring in pseudopseudohypoparathyroidism. (Korean J Dermatol 2009;47(7):820~824)
잉어 담낭 생식 후 병발된 횡문근융해증 및 급성신부전과 급성간염 1예
김학준,김용진,이인희,박정기,정의달,여동근,윤원찬,조선주,안기성 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.5
Sevral cases of acute renal failure and acute hepatitis after ingestion of raw carp gall bladder have been reported. We experienced for the first time 1 case of acute renal failure and acute hepatitis associated with rhabdomyolysis, which has not been seen in previous studies, after ingestion of the raw carp gall bladder. Serum creatine phosphokinase, myoglobin and urine myoglobin were increased and 99mTc-MDP bone scan showed diffusely increased uptake of isotope in soft tissue of whole body. The other laboratory data corresponded to acute tubular necrosis and acute toxic hepatitis. The kidney pathology showed the recovery phase of acute tubular necrosis. Etiologic factor for rhabdomyolysis was not found except carp gall bladder. We considered that carp gall bladder was etiologic factor for rhabdomyolysis and that rhabdomyolysis acted as agravatting factor for developing acute tubular necrosis due to carp bile toxicity in this case.
소화성궤양 출혈의 내시경적 지혈술 후의 조기 재출혈에 관한 우험 인자 분석
최병렬,서영진,박순우,배정동,김호각,박정기,정의달,권중구,이창형 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.6
Backgrund/Aims: Rebleeding rate after initial endoscopic hemostasis in patients with ulcer hemorrhage has been reported in 20-30%, Identification of patients who are at high risk for rebleeding would be expected to improve the outcome of endoscopic hemostasis. The purpose of this study was to evaluate risk factors for early rebleeding after initial hemostasis in the view of clinical and endoscopic characteristics. Methods: We reviewed 99 patients who presented with bleeding peptie ulcers and were treated with endoscopic hemostasis including hypertonic saline injection, electrocautery and clipping. We compared the clinical variables (age, pulse rate, hemoglobin), endoscopic characteristics of ulcer (size, number, and location of ulcer, clots on the base, bleeding stigmata, size and color of exposed vessel) between the patients who bled early (n=22) and who didnt bleed (n=77) within 5 days. Results: The statistically significant correlates with early rebleeding after hemostasis were number of comorbid illness (≥2) (p=0.031), volume of transfusion (≥5 units) (p=0.001), size of ulcer (>1 cm) (p=0.038), multiple ulcers (p=O.O2O), presence of blood clots on ulcer base (p=0.012), stigmata (active bleeding and visible vessels) (p=0.010), size of exposed vessel (>1 mm) (p<0.0001). In multivariate analysis, volume of transfusion (odds ratio[OR] 14.4), size of ulcer (OR 11.7), multiple ulcers (OR 5.5) and size of exposed vessel (OR 13.2) were significant risk factors. Conclusions: The risk factors for early rebleeding after hemostasis in bleeding peptic ulcer can be predicted by clinical variables and endoscopic findings. Early identifieation of risk factors such as transfusion over 5 units, large-sized ulcer, multiple ulcers, bleeding stigmata and size of exposed vessei over 1 mm can predict the prognosis of peptic ulcer bleeding.
공터키안(Empty sella)을 동반한 급성췌장염으로 발현된 부갑상선 선종 1예
전언주,오지혜,배경륜,장샛별,전승운,정의달,손호상,원규장 영남대학교 의과대학 2009 Yeungnam University Journal of Medicine Vol.26 No.1
The incidence of coexisting hyperparathyroidism and empty sella syndrome is rare and the etiology and incidence of their coexistence is not known. The association of hyperparathyroidism and the empty sella syndrome may be related to multiple endocrine neoplasia (MEN) syndrome due to a genetic disorder. We experienced a rare case of hyperparathyroidism presenting as acute pancreatitis combined with empty sella. We report here a 37-year old female who manifested epigastric pain because of acute pancreatitis. She had hypercalcemia due to parathyroid adenoma. A pituitary gland was not visible in the sella turcica on MRI scans. On genetic analysis, she did not show a mutation of the MENIN gene. Empty sella is thought to be a coincidental finding with hyperparathyroidism.