Primary hypothyroidism follow by generalized resistance to thyroid hormine

채봉남 ( Bong Nam Chae ),박지원 ( Jee Won Park ),이미덕 ( Mi Deok Lee ),홍은경 ( Eun Gyoung Hong ),정윤석 ( Yoon Sok Chung ),이은지 ( Eun Jig Lee ),김현만 ( Hyeon Man Kim ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

Primary idiopathic hypothalamic hypothyroidism

채봉남 ( Bong Nam Chae ),박지원 ( Jee Won Park ),이미덕 ( Mi Deok Lee ),홍은경 ( Eun Gyoung Hong ),정윤석 ( Yoon Sok Chung ),김현만 ( Hyeon Man Kim ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

한국인에게서 당뇨병성 말초 신경병증을 선별하기 위한 문진표의 유용성

정윤석(Yoon Sok Chung),채봉남(Bong Nam Chae),홍은경(Eun Gyoung Hong),이성규(Seong Kyu Lee),노혜림(Hae Lim Noh),김윤정(Yoon Jung Kim),신영구(Young Goo Shin),이관우(Kawn Woo Lee),김현만(Hyeon Man Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.1

N/A Discrepancies exist in the currently available data on the prevalence of diabetic neuropathy. Variations in the prevalence of diabetic neuropathy have reflected the different criteria used to form its diagnosis. The majority of diagnostic criteria are less practical in many routine clinical settings where there is a need for a simple assessment using widely available techniques to rapidly screen large numbers of patients. We already reported that the questionnaire of Feldman's two-step assessment was less useful in Koreans, because of the different expression of neuropathic symptoms. We proposed a representative questionnaire which was based on patients' own complaints, and assessed its clinical availability. Methods : Ninety diabetic patients(45 cases with diabetic neuropathy, 45 cases without neuropathy) were included in this study. Diabetic neuropathy was diagnosed by neurologic examination and nerve conduction velocity. The questionnaire consisted of 7 questions on foot sensation (prickling, lancinating, burning, numb), which are frequent complaints of diabetic patients. All subjects were assessed with the questionnaire. Results : 1. The most sensitive symptom was tingling sensation (75.6%) and the least sensitive one was numbness(28.9%). 2. The most specific symptom was numbness(82.2%) and the least specific one was tingling sensation(33.3%). 3. If we would assume that three or more of symptoms were diagnostic, the sensitivity and specificity were 66.7% and 53.3%, respectively. Conclusion : Our new questionnaire can be used as a screening test or a follow-up tool for the diagnosis of diabetic peripheral neuropathy in Koreans.

십이지장궤양 환자에서 Helicobacer pylori 의 박멸이 궤양 재발에 미치는 영향에 관한 연구

김나영(Na Young Kim),윤여학(Yeo Hak Yoon),조윤숙(Yun Suk Cho),채봉남(Bong Nam Chae),최진용(Chin Yong Choi),이계희(Kye Heui Lee),손인(In Son),박성훈(Sung Hoon Park),구명숙(Myoung Sook Koo),최신은(Shin Eun Choi) 대한내과학회 1993 대한내과학회지 Vol.45 No.3

N/A Background: The recurrence rate of duodenal ulcer (DU) within 12 months after treatment is 70~90%. Since the identification of Helicobacter pylori (H. pylori) which has been confirmed to be the major causal agent of chronic antral gastritis, the close linkage between the chronic antral gastritis and DU, and the presence of H. pylori in the stomach of more than 90% of patients with DV have stimulated studies on the use of anti-H. pylori antimicrobial agents in DU. However, the definition of eradication related with the time at which assessment is made after the completion of therapy has not been unified, and moreover, there is no general agreement on how H. pylori should be eradicated. Methods: This study was performed for 190 DU patients and four different methods -culture, Gram stain of touch print, H&E stain, mucosal urease test-were taken for H. pylori test just before treating to identify the infection rate of H. pylori in DU patients, immediately after each 6 week ulcer therapy to assess the negative conversion rate of H. pylori, and 4 weeks later after the completion of ulcer therapy to find the eradication rate of H. pylori in each treatment group (cimetidine, omeprazole, colloidal bismuth subcitrate (CBS), CBS and metronidazole double therapy, CBS, metronidazole and amoxicillin triple therapy). To detect DU recurrence, the gastroscopy was performed at 6, 12 and 18 months after therapy. Results : 1) The infection rate of H. pylori in DU patients in Korea was 94.2%. 2) The negative conversion rate of U. pylori immediately after the therapy in cimetidine group was 0%, and that of omeprazole group was 16.7% but one half of the negative converted cases was converted to be positive 4 weeks later after the completion of therapy, so the eradication rate was 8.3%. In CBS group, the negative conversion rate was 33.3% but in all of these patients H. pylori convereted to be positive, so the eradication rate was 0%. In double therapy group, the negative conversion rate was 81.0% but 61.5% of these patients persisted to be negative 4 weeks later after therapy, so the eradication rate was 47.1% which is higher than that of cimetidine, of omeprazole, of CBS group. In triple therapy group, the negative conversion rate of H. pylori was 96.7%, and 92% of these patients persisted to be negative, so the eradication rate was 88.5%, which is higher than that of double therapy group. 3) The DU recurrence rate of cimetidine group was 63.6% in 1 year and 81.8% in 18 months later, respectively, and in omeprazole group that was 58.3% both in 1 year and 18 months later. In CBS group, that was 33.3% in 1 year and 44.4% in 1H months later. In double therapy group, that was 12.5% in 1 year and 18.8% in 18 months later, respectively. In triple therapy group, that was both 3.8% in 1 year and 18 months later. 4) When all of these patients were classified into two groups according to the eradication of H. pylori, the recurrence rate was 0% in the 32 patients with H. pylori eradicated, and that WBS 57.1% (24 patients) in the 42 patients with H. pylori not eradicated. Conclusion : From these results, we can conclude that in order to evaluate the eradication of H. pylori, it is more precise to assess the H. pylori 4 weeks later after the completion of therapy than immediately after the therapy, and the eradication of H. pylori in DU patients reduces the recurrence of DU.

십이지장궤양 치료방법에 따른 Helicobacter pylori의 박멸에 관한 연구

최진용(Jin Yong Choi),김나영(Na Young Kim),윤여학(Yeo Hak Yoon),조윤숙(Yun Sook Cho),채봉남(Bong Nam Chae),이계희(Kye Heui Lee) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A The recurrence rate of duodenal ulcer(DU) within 12 months after treatment has been re- duced to 0-27% with eradication of Helicobacter pylori(H. pylori) from 50-90% without eradi- cation. This study was conducted to find the ideal method of treatment in the aspects of erad- ication of H. pylori, symptom reduction, and side effect among the three treatment methods. This study was performed for 73 patients with DU, and four different methods, for identifying H. Pylori infection-Gram stain of touch print, culture, H&E stain, CLO test-were taken just be- fore treatment and taken 4 weeks later after the completion of ulcer therapy to find the eradi- cation rate of H. pylori in three treatment groups. The first treatment group consisted of col- loidal bismuth subcitrate(CBS) 240mg twice a day, metronidazole 250mg thrice, and amoxicillin 500mg thrice for 6 weeks(Group I, n=28), the second group omeprazole 20mg once a day for 6 weeks and amoxicillin 500mg thrice for the first two weeks(Group II, n=l3), and the third group ranitidine 150mg twice a day or omeprazole 20mg once for 4 weeks and thereafter CBS 120mg four times a day, metronidazole 500mg thrice and amoxicillin 500mg four times for 2 weeks(Group III, n=32). The degree of symptom reduction and frequency of side effect in each treatment group were evaluated during the treatment period. The eradication rate of H. pylori was 89.3% in Group I, 23.1% in Group II, and 87.5% in Group Ill, In Group I, more than 50% of symptom reduction within 1 week was 55.6%, within 2 weeks 22.2% and after 2 weeks 22.2%; in Group II, more than 50% of symptom reduction within 1 week was 100%; in Group III, the same rate of reduction within 1 week was 96.6% and within 2 weeks 3.4%. The frequency of side effect in Group I was 21.2% including 5 patients (15.2%) in whom the medication could not be completed due to major side effect; the frequen- cy of side effect in Group II was 0%; that in Group lIl was 21.9/, in all of whom the side effect was minor so the medication could be completed. From these results, we concluded that in the aspect of eradication of H. pylori, the triple therapies for 6 or 2 weeks(Group I and Ill) are better than omeprazole and amoxicillin therapy(Group II), and in the aspect of symptom reduction, the triple therapy for 2 weeks after ranitidine or omeprazole for 4 weeks(Group Ill) is better than the triple therapy for 6 weeks (Grup I ). (Korean J Gastroenterol 1994; 26: 47 55)

일차성 골다공증 여성 환자에서 주기적인 pamidronate 정주 치료

채봉남,홍은경,이성규,정윤석,이관우,김현만 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.2

Background: Bisphosphonates are now well established as successful antiresorptive agents for the prevention and treatment of osteoporosis. We investigated the effect of cyclic intravenous treatment with an aminobisphosphonate, pamidronate in cases of primary osteoporosis. Methods: Eighteen patients with primary osteoporosis (bone mineral density BMD t-score <-2.5) received four courses of pamidronate (30 mg with 500 mL normal saline over 2 hours every 3 months). The serum biochemical parameters and bone turnover markers were measured before each treatment. The bone pain score, medication score, and the side effects were also monitored. BMD and simple spine X-ray were performed before and 1 year after of treatment. Results: BMD at the lumbar spine (L2-4) significantly increased from 0.798±0.110 g/㎠ to 0.860±0.107 g/㎠ after 1 year of treatment with pamidronate: by +8.3±9.4% of baseline. BMDs at the femoral neck, Ward s triangle and the trochanter also increased, but not significantly. Serum total alkaline phosphatase (p<0.05) and urine deoxypyridinoline/creatinine (p=0.069) decreased with treatment. Other bone turnover markers were unchanged. The bone pain score decreased significantly. None of the patients experienced a new fracture during treatment. The frequency of the side effects following the first infusion was 61.1% (a transient fever and myalgia with flu-like symptoms in 10 patients and mild phlebitis in 1 patient). However, only two patients complained of flu-like symptoms after second infusion, and no patient complained following the third infusion. Conclusion: Cyclic intravenous treatment of pamidronate every three months was effective in increasing BMD and in the decreasing bone turnover rate, and was relatively well tolerated in primary osteoporotic women.

정상 쥐와 당뇨병 쥐에서 임신시 췌장의 비교

채봉남 관동대학교 의과학연구소 2000 關東醫大學術誌 Vol.4 No.1

Under the influence of pregnancy, the β-cells of islet undergo major long term up-regulatory structural and functional changes in response to the increased demand for insulin. Histo-morphometry studies indicated that during pregnancy, islet mass was increased from 1.4-fold to 3-fold and insulin secretion was also increased. this study was focused the change of β -cells of pancreas in streptozotocin-induced diabetic pregnant rat. And we compare this result with β -cells of pancreas in normal pregnant rat. Sprague-Dawley rat divided four group: normal control, normal pregnancy, diabetes group, and diabetic pregnancy group. The rats of diabetes and diabetic pregnaney group were injected amount of 40 mg/kg of streptozotocin. All rats of four groups were tested oral glucose tolerance test on days 10 after streptozotocin injection and on days 18 of pregnancy. On 18 days of pregnancy, we observed islets of pancreas under the light microscopy with insulin immunohistochemical stain, and under the electron microscopy. Streptozotocin-induced diabetic rat had higher fasting glucose and integrated glucose area under the curve (GAUC), and lower fasting insulin level than normal rat(p〈0.05). But there was no significant difference of integrated areas under the insulin secretion response curve (IAUC). During pregnancy fasting glucose and GAUC were decreased insignificantly, but fasting insulin and IAUC were increased significantly in normal rat. But in diabetic rat, there were no significant difference in fasting insulin, glucose and GAUC during pregnancy except IAUC. Under the light microscopy, the area of β -cells by insulin immunohistochemistry was increased insignificantly in pregnant rat than in non-pregnant rat. The estimate far the increase in β -cells area during pregnancy in diabetic rat was 7.09% compare to 20.22% in normal rat. And the estimate for the increase in the number of islets in diabetic rat was 14.9% compare to 29.4% in normal rat. In conclusion, the area of β -cells and number of islets of pancreas in both normal and streptozotocin-induced diabetic rat during pregnancy were insignificantly increased. But the rate of increase in streptozotocin-induced diabetic rat was a half or one thirds to normal. So It was supposed that the structural change of endocrine pancreas during pregnancy was insufficient. In future, the mechanism of increase of endocrine pancreas mass during pregnancy was further studied. So it will indicate the way of treatment in pregnant diabetes and give a remedy of gestation diabetes.

다양한 대사적 이상을 나타낸 가족성 복합 고지혈증 가계 1예

김현만,이관우,채봉남,김윤정,이성규,홍은경,박지원,정윤석 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.2

Familial combined hyperlipidemia is one af the manogenic disorders frequently found in humans and is seen in 0.5~2% of the general populatian, accounting for at least 10% of persons with pemature atlmmcletusis. The distinguishing feature of familial combined hyperlipidemia, in camparison with other single-gene abnarmalities of lipoprotein metabolism, is that not all affected members have the same plasma lipid phenotype; some individuals have an elevation of cholesterol concentration alane(type IIa lipoprotein pattern), while some athers have an elevation of triglyceride concentration alone(type IV pattem), and still others have elevations of both values(type IIb pattem). In any one persan, the lipid phenotype can change as a result of dietary or drug treatment. Familial combined hyperlipidemia should be suspected in those subjects with moderate hypertriglyceridemia and/or moderate hypercholestaolemia (lipoprotein types IIa, Ilb, IV), especially when premature coronary heart disease is evident in the family histary. Low plasma HDL-cholesterol, obesity, insulin resistance and hyperuricemia are often . Family members affected by familial combined hyperlipidemia should be identified and be treated, since tbe condition is associated with premature caronary heart diasease. We have found one family of familial combined hyperlipidemia with one member(case 1) associated with insulin resistance, hyperuricemia and gout, and another member(case 2) associated with diabetes mellitus and infertiTity. (J Kor Soc Endocrinol 14:418-424, 1999)

갑상선을 침범한 다발성 Langerhans 세포 육아종증 1예

김현만,이관우,채봉남,김윤정,이성규,홍은경,정철권,정윤석,박소윤,황성철,임현희 대한내분비학회 1998 Endocrinology and metabolism Vol.13 No.3

Langerhans cell granulomatosis(LCG), previously termed 'Histiocytosis-X', is one of the rare disease. LCG is characterized by proliferation of Langerhans cells in a unifocal or multifocal pattern. And LCG may be manifested in a variety of way, ranging from a spontaneously regressing solitary lesion to a multisystem life-threatening disorder. This disease usually involves the bone, lung, skin and lymph node. The most common endocrinologic abnormalities in LCG are diabetes insipidus and growth hormone deficiency. LCG involving the thyroid gland is extremely rare and only a small numbers of cases have been reported worldwide. A 41-year-old diabetic female visited the hospital due to the neck swelling for 3 months and she also complained of polyuria, polydipsia and easy fatigue. LCG involving multiple organs included thyroid gland was diagnosed by high-resolution CT of lung, by characteristic histological findings of the thyroid lesion and by the immunohistochemical staining for S-100 protein and OKT 6(CD la). She is followed at OPD without any medication (J Kor Soc Endocrinol 13:466- 472, 1998).

제2형 당뇨병 환자와 정상인에서 혈중 렙틴 농도와 인슐린저항성 및 비만도와의 관계

김현만,이관우,채봉남,김윤정,이성규,홍은경,정윤석,노혜림,오윤정 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.1

Background: Leptin has been reported to be correlated with the amount of adipose tissue in humans. The plasma leptin concentrations were not different between diabetics and non-diabetics in Mexican-Americans; however, the leptin might stimulate or diminish insulin secretion and induce insulin resistance. Then, it can be postulated that leptin may one of the key factors in the development of insulin resistance. Therefore we were to note any differences in FPL (fasting plasma leptin levels) between diabetics and normal subjects, and to investigate variables such as PBF (percentage body fat), BMI (body mass index), FPI (fasting plasma insulin) to determine their effects on the variation of FPL. We also were to investigate whether FPL influenced the GUR (glucose utilization rate). Methods: The subjects were 116 type 2 diabetics and 45 normal subjects in Korean. PBF, BMI, WHR (waist hip ratio) were measured. Fasting plasma insulin and leptin levels were measured by radioimmunoassay. Euglycemic and/or hyperglycemic clamp tests were performed in 19 diabetics and 16 normal subjects. Results: 1. There was no difference in FPL between diabetics and normal subjects. 2. A significant difference was found in FPL between female and male subjects. 3. Gender and body composition such as PBF, BMI contributed plasma leptin levels. 4. FPL was associated with GUR (Insulin resiatance) only in male subjects. 5. During 2h clamp tests, the acute increments of insulin or glucose did not change the leptin levels. Conclusion: These data suggested that there was no difference in FPL between diabetics and normal subjects, whereas gender, body composition such as PBF, BMI contributed leptin levels (J Kor Soc Endocrinol 14:122133, 1999).