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호산구증다증을 동반한 P-ANCA 양성 괴사성 사구체신염
신장열 ( Jang Yel Shin ),강이화 ( Ea Wha Kang ),류동렬 ( Dong Ryeol Ryu ),송정식 ( Jung Sik Song ),이원기 ( Won Ki Lee ),박용범 ( Yong Beom Park ),김루시아 ( Lucia Kim ),정현주 ( Heun Ju Jung ),이수곤 ( Soo Kon Lee ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.1
Antineutrophil cytoplasmic antibodies (ANCAs) are now regarded as a serologic marker for pauci-immune crescentic necrotizing glomerulonephritis either in renal-limited form or in association with systemic vasculitis, such as Wegener`s granulomatosis, microscopic polyarteritis, and Churg-Strauss syndrome. Two major ANCA antigens have been indentified: proteinase3, which produces a cytoplasmic staining pattern termed C-ANCA, and myeloperoxidase, which produces a perinuclear pattern termed P-ANCA on ethanol-fixed neutrophils by indirect immunofluorescence. In ANCA- associated diseases, eosinphilia in excess of 1.5×10(9)/L has been proposed to be characteristic of Churg-Strauss syndrome and is rare in other forms of ANCA-associated systemic vasculitis and crescentic necrotizing glomerulonephritis. Recently, there were two cases of P-ANCA positive crescentic necrotizing glomerulonephritis with peripheral blood eosinophilia and extrarenal microscopic vasculitis without asthma or granulomas. We experienced a patient with P-ANCA positive pauci-immune necrotizing glomerulonephritis with few eosinophilic infiltration and eosinophilia. He improved with oral prednisolone along with combination of intravenous cyclophosphamide. So we report this case with the review of literature.
증례 : 내분비-대사 ; 융모 상피성 종양을 진단받은 환자에서 발병한 갑상선 유두암 1예
김재현 ( Jae Hyun Kim ),김송이 ( Song Yi Kim ),이미영 ( Mi Young Lee ),신장열 ( Jang Yel Shin ),신영구 ( Young Goo Shin ),정춘희 ( Choon Hee Chung ) 대한내과학회 2011 대한내과학회지 Vol.80 No.4
갑상선 암은 가장 흔한 내분비암 중 하나이다. 갑상선은 성호르몬과 β-HCG 등의 영향을 받기 때문에 β-HCG가 증가되는 임신시나 융모 상피성 질환에서 갑상선 질환의 발생이 촉진 될 수 있다고 알려져 왔다. 하지만 융모 상피성 종양 환자에서 갑상선 암이 동반된 경우는 아직까지 국내에서 보고되지 않았다. 이에 저자는 융모 상피성 종양 환자에서 갑상선 유두암이 동반된 사례를 경험하였기에 문헌고찰과 함께 보고한다. Thyroid cancer is one of the most common endocrine malignancies. It is known that thyroid cancer can develop during reproductive periods, possibly due to the effects of sex hormones and growth factors such human chorionic gonadotrophin (HCG). Some data suggest that elevated HCG levels during pregnancy or gestational trophoblastic disease can stimulate thyroid cellular proliferation and promote cancer formation; however, a case of papillary thyroid cancer accompanied by a gestational trophoblastic tumor has not been reported. Here, we report the case of a 44-year-old woman with papillary thyroid cancer during treatment for a gestational trophoblastic tumor. (Korean J Med 2011;80:464-468)
김도영(Do Young Kim),김대중(Dae Jung Kim),신장열(Jang Yel Shin),박효경(Hyo Kyoung Park),김진석(Jin Suk Kim),윤영연(Yeong Yeon Yun),김철우(Cheol Woo Kim),박중원(Jung Won Park),홍천수(Chein Soo Hong) 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.1
N/A Background and objective .There has been little clinical data on the treatment outcome of pa- tients with acute asthma attack in Korea. We designed a management protocol of acute asthma, and analyzed clinical parameters obtained from this protocol. Method: A total of 32 cases with acute asthma were treated with oxygen, β2 agonist, and methylprednisolone. Ipratropium was added in cases of severe attack. After 90 minutes, intravenous aminophylline was given to the patients with poor response. Result: Beta2 agonist and methylprednisolone were sufficient for symptom control in 17 cases. Ipratropium and aminophylline were added in 6 and 9 cases, respectively. There was no difference in improvement of PEF, heart rate, respiratory rate, PaO2, PaCO2, and SaO2 at 90 minutes and 8 hours between agonist inhalation and subcutaneous group. Serum potassium concentration levels significantly decreased in patients treated with ipratropium or aminophylline (n=15, 4.17+0.45 vs. 3.99±0.35mM/L, p<0.05), compared with patients using only agonist and methylprednisolone (n=17, 3.89+0.30 vs. 4.14+0.46mM/L, p>0.05). Conclusion Subcutaneous agonist may be an alternative to inhalant 0z agonist for the emergency treatment of acute asthma, and we think that a consensus regarding use of aminophylline in the emergency room should be made.
증례 : 내분비-대사 ; Dyke-Davidoff-Masson 증후군 환자에서 발생한 뇌하수체 기능저하증과 당뇨병 1예
박소연 ( So Yeon Park ),이미영 ( Mi Young Lee ),김재현 ( Jae Hyun Kim ),김송이 ( Song Yi Kim ),신장열 ( Jang Yel Shin ),신영구 ( Young Goo Shin ),정춘희 ( Choon Hee Chung ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3
저자들은 생후 일찍 경련이 발생하여 부전마비 임상적 소견, 방사선학적 검사 및 유전학적 검사를 통해 Dyke-Davidoff-Masson 증후군이 진단된 환자에서 뇌하수체 기능저하증 및 당뇨병이 동반된 사례를 경험하였기에 보고하는 바이다. Dyke-Davidoff-Masson syndrome (DDMS) is a rare condition characterized by asymmetric cerebral hemispheric growth with unilateral atrophy, ipsilateral compensatory osseous hypertrophy, hyperpneumatization of the paranasal sinuses and mastoid cells, and contralateral paresis. Varying degrees of hemiparesis, hemiplegia, seizures, mental retardation, and facial asymmetry can be associated with DDMS. We report the case of a 26-year-old man with DDMS associated with hypopituitarism who complained of polydipsia and polyuria. After an oral glucose tolerance test, he was diagnosed with type 2 diabetes. There is no report of DDMS associated with other pituitary dysfunction or hyperglycemia. Clinicians should consider the possibility of coexisting pituitary dysfunction or type 2 diabetes in patients with DDMS, as it is obviously important for the patient`s outcome. (Korean J Med 79:316-320, 2010)
한국 제2형 당뇨병 남성에서 FGF-21과 비알코올성 지방간의 연관성
한용재 ( Yong Jae Han ),허지혜 ( Ji Hye Huh ),성재호 ( Jae Ho Seong ),임정수 ( Jung Soo Lim,),이미영 ( Mi Young Lee ),정춘희 ( Choon Hee Chung ),신장열 ( Jang Yel Shin ) 대한내과학회 2015 대한내과학회지 Vol.88 No.3
Background/Aims: Serum fibroblast growth factor-21 (FGF-21) levels are elevated in obesity, metabolic syndrome, and type 2 diabetes. Clinical studies have demonstrated an association between FGF-21 and nonalcoholic fatty liver (NAFL) in the general population. This study investigated the association between FGF-21 and NAFL in Korean men with type 2 diabetes. Methods: Clinical and biochemical metabolic parameters were measured in 135 Korean men with type 2 diabetes (mean age: 56.2 ± 9.2 years; HbA1C: 7.6 ± 1.5%). Serum FGF-21 was determined by enzyme-linked immunosorbent assay. NAFL severity was assessed by ultrasound of the liver. High-grade (hg) NAFL was defined as moderate or severe fatty liver. Results: The patients were divided into three subgroups according to NAFL severity: normal (17.0%), low-grade (50.4%), and high-grade (32.6%). Patients with hgNAFL had a larger waist circumference and higher body mass index (BMI), homeostatic model assessment-estimated insulin resistance (HOMA-IR) score, and triglyceride (TG), liver enzyme, and FGF-21 levels than those with a normal liver. FGF-21 correlated positively with BMI, serum creatinine (Cr), TG, liver enzymes, and high-sensitivity C-reactive protein, but negatively with high density lipoprotein (HDL). In multivariate regression analysis, Cr and TG were independently associated with FGF-21. BMI, TG, HDL, HOMA-IR, and FGF-21 correlated strongly with hgNAFL. The odds ratio (OR) of a 1-standard-deviation increase in FGF-21 predicting hgNAFL was 2.39 (95% confidence interval, 1.55?3.68). The OR remained significant after adjustment for Cr, TG, BMI, and HOMA-IR. Conclusions: Our findings suggest an independent association of serum FGF-21 with NAFL in Korean men with type 2 diabetes. (Korean J Med 2015;88:273-280)
김도영,신장열,허갑범,이현철,임승길,김경래,송영득,남재현,안철우,최규헌,조정래,이준규,남수연,한재호,정현주 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.1
Banter's syndrome is characterized by hypokalemia, metabolic alkalosis, hyperreninemia and secondary hyperaldosteronism without hypertension and edema. Histologically, existing hyperplasia of the juxtaglomerular cell occurs mostly in childhood or adolescence, and initial presentation in patients over 40 years old of age is very rare. It has been recorded that Bartter's syndrome is associated with glucose intolerance, but not with overt diabetes mellitus. Whether this association is coincidental or causal is uncertain, although hypokalemia can cause glucose intolerance. We experienced a case of Banter's syndrome in 44 years old non-insulin dependent diabetic woman. She improved with potassium supplements along with combination of prostaglandin synthetase inhibitor and aldosterone antagonist. We report present case with the review of literature.