폐 자궁내막 증식증

김기중 ( Ki Joong Kim ),조윤형 ( Yoon Hyung Cho ),최병기 ( Byeong Kee Choi ),최의영 ( Eui Young Choi ),장윤수 ( Yoon Su Chang ),김형중 ( Hyung Jung Kim ),안철민 ( Chul Min Ahn ),조상호 ( Sang Ho Cho ),유진아 ( Jin A Rhu ) 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.47 No.3

한국인 성인 비만증에서 당대사에 따른 렙틴 농도와 인슐린 및 체지방 분포와의 상관성

남수연,신재호,최병기,김경옥,김경래,송영득,임승길,이현철,허갑범 대한비만학회 1999 The Korean journal of obesity Vol.8 No.2

Background: Women have higher circulating leptin levels than men with similar degree of obesity. This difference between sex might be explained by the differences in body fat distribution. Insulin has been reported to regulate leptin level. We investigated that the leptin levels in obese subjects with varying glucose tolerance and its relationship to the body fat distribution and insulin levels. Methods: We measured body mass index (BMI), ideal body weight (IBW) and waist-hip ratio (WHR) in all subjects. Total body fat amount was determined by bioelectric impedance. CT scan was peiformed to measure visceral and subcutaneous fat area at the umbilicus level. We divided obese subjects to three subgroups (normal glucose tolerance group; NGT, impaired glucose tolerance group; IGT, type 2 DM group) according to the results after oral glucose tolerance test (OGTT). Results: The IBW, BMI and total body fat were not significantly different between three obese subgroups. Male subjects had more visceral fat areas, whereas female had more subcutaneous fat. The leptin levels were higher in obese groups than control group. The obese IGT group in fernale subjects and the obese NGT group in male subjects had the highest leptin level. In all female subjects, the subcutaneous fat area explained the 41.5% of variance in leptin level. In all male subjects, bothe subcutaneous fat area and fasting insulin level explained the 77.2% of the leptin levels. Conclusion: We demonstrated that the sex difference in leptin levels was explained in part, by the difference of body fat distribution, especially the amount of subcutaneous fat, irrespective of glucose tolerance. In male subjects who had prominent insulin resistance associated with visceral fat accumulation, chmnic hyperinsulinemia can significantly influence the levels of leptin.

현미경적 폐전이를 동반한 갑상선 유두암 1예

정현주,허갑범,이현철,임승길,김경래,남수연,최병기,최소래,허애정,송영득 대한내과학회 1999 대한내과학회지 Vol.56 No.6

Although the papillary thyroid carcinoma generally follows an indolent course characterized by slow growth and abscence of distant metastasis, distant metastases to extrathyroid organ may occur in the lung, bone and brain in about 5% of patients. The lung metastases are usually diagnosed by plain X-ray, chest CT and 131I whole body scan. However, we present a case of papillary thyroid carcinoma with microscopic pulmonary metastasis that could not be detected by conventional method, such as chest X-ray, chest CT and 131I whole body scan. A 62-year-old female visited due to traumatic hemopneumothorax. In the pathology of resected tissues from lacerated lung parenchyme, metastatic papillary carcinoma was diagnosed without evidence of abnormality in radiologic examination and we diagnosed and treated an asymptomatic papillary thyroid carcinoma.

체지방분포도가 당대사, 지질대사 및 성장호르몬 분비에 미치는 영향

허갑범,이현철,임승길,김경래,송영득,남수연,김경욱,정대호,최병기,허애정 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.3

Background: Body fat distribution, rather than the level of obesity per se, appears to be a strong predictor of abnormalities in metabolic complication. Visceral fat accumulation is significantly correlated with glucose intolerance and constitutes as an independent risk factor for the diabetes mellitus. Methods: We investigated the impact of body fat distribution on the glucose, lipid metabolism and growth hormone secretion in obese subjects with varying glucose tolerance and lean controls matched with sex and age. 69 obese Koreans (34 men, 35 women; 43.8 yrs) and 21 lean Koreans (10 men, 11 women; 40.8 yrs) were recruited. Anthropometric measurement and impedence for measurement of total body fat, and computed tomography for visceral and subcutaneous fat area at umbilicus level were performed. All subjects underwent a standard oral glucose tolerance test and GH stimulation test by L-dopa. Results: The results are summarized as follows. 1. Obese patients had greater ideal body weight (%, IBW) and lean body mass (LBM) than lean controls. But no significant differences were found in IBW and LBM between 3 obese groups. 2. The 25 obese NIDDM had the highest FFA-AUC during OGTI and the lowest GH-AUC to L-Dopa stimulation test. The insulin-AUC during OGTT was the highest in 24 obese subjects with normal glucose tolerance. 3. All male groups have VSR of more than 0.4, which has been designated visceral fat obesity. In contrast all female groups have VSR of lesser than 0.4 but obese DM subjects have the highest VSR. Visceral fat area per body weight ratio(VWR) showed increasing tendency in obese, IGT, and DM group. 4. Waist circumference and VWR showed strong correlation with metabolic parameters among anthropometric parameters. They were positively correlated with FFA-AUC during OGTT and negatively correlated with GH-AUC to L-dopa stimulation. Conclusion: Visceral fat accumulation are associated with insulin resistance, dyslipidemia and impairment of growth hormone secretion via increase of free fatty acid. The simple waist circumference may provide a more practical indicator that correlated with aMominal fat distribution and metabolic complications associated with obesity (J Kor Soc Endocrinol 14:541-552, 1999).

고프로락틴혈증에서 요중 안드로겐 대사물 측정의 의의

김은숙,허갑범,이현철,임승길,신재호,이은직,송영득,남수연,최병기,김경래,정봉철 대한내분비학회 1997 Endocrinology and metabolism Vol.12 No.3

Background: Hyperprolactinemia has been linked with hyperandrogenism and hirsutism in some women. High plasma Dihydroandrosterone and DHA-S levels were reported in patients with hyperprolactinemia and a dissociation of adrenal androgen and cortisol secretion occurs in normal subjects. The mechanism has not been elucidated, but it has been suggested that pituitary factors other than ACTH modulate adrenal androgen synthesis, One candidate hormone is prolactin. Adrenal tissue has been found to possess prolactin receptors and prolactin has been shown to act synergistically with ACTH and lowers the activity of the enzyme 5a-reductase or 3B- hydroxysteroid dehydrogenase(3B-HSD). The aim of this study was to investigate the secretion of adrenal androgen metabolites in patients with idiopathic hyperprolactinemia and prolactinoma and to deterrnine the relationship with prolactin and androgens. Methods: We measured 24 hour-urinary DHEA, androstenedione, androsterone, pregnenolone, tetrahydrocorticoid and cortisol in 16 normal controls and 5 patients with idiopathic hyperprolac- tinemia(HP) and 12 patients with prolactonoma in the early follicular phase. Results: Urinary DHEA, AD(androsteredione), and androsterone, the metabolites of adrenal androgen, were significantly higher in both patients with idiopathic HP and prolactinoma compared with those in normal controls(p$lt;0.05), whereas they were not different in both disease groups. Urinary pregnenolone levels, early metabolite of adrenal steroid synthesis, were lower in patients. In contrast, urinary tetrahydorcortisol and cortisol were higher in patients compared to controls. There was no difference in DHEA:androsterone ratio between patients and controls. And there were no correlation between prolactin levels and the levels of androgenic metabolites or clinical symptoms. Conclusion: Prolactin has a tropic effct on the secretion of androgens and steroids by the adrenal cortex. But prolactin levels were not correlated with androgen levels or clinical symptoms (amenorrhea), and it might have little effect on lowering the activity of 3B-HSD. (J Kor Soc Endocrinol 12:443-449, 1997)

췌장암과 감별이 필요하였던 비알코올성 만성 췌장염 1예

이상인,강진경,윤동섭,박영년,정재복,이세준,정준표,이관식,송시영,나상규,최병기,송기섭,유정식 대한소화기학회 2000 대한소화기학회지 Vol.35 No.6

Differentiation between chronic pancreatitis and pancreatic cancer is often difficult. Some special types of chronic pancreatitis such as 'non-alcoholic duct-destructive chronic pancreatitis' and 'chronic pancreatitis with diffuse irregular narrowing of the main pancreatic duct' seem to be pancreatic cancer, but show imaging features characterized by the absence of parenchymal atrophy, significant ductal dilatation proximal to the site of stenosis, and the absence of extrapancreatic spread. Recognition of these special types of chronic pancreatitis prior to a definite treatment is important to avoid an unnecessary pancreatic resection. Recently, we experienced a case of non- alcoholic chronic pancreatitis in a 80-year-old man presenting with obstructive jaundice. His radiologic features were similar to those of non-alcoholic duct-destructive chronic pancreatitis. Recognition of this special type of chronic pancreatitis prior to a definitive treatment enabled us to manage this patient optimally.